Understand the effects of cancer treatment and prevention on fertility and family planning, how pregnancy impacts hereditary cancer risk and options for assisted reproduction.
The effects of cancer treatment on fertility
Some cancers and cancer treatments can affect fertility in women and men. These effects may be temporary or permanent. This is particularly true for individuals with cancers caused by inherited mutations because they are more likely to be diagnosed at an earlier age, before they have completed their family.
Both men and women have options for preserving their fertility after a cancer diagnosis. National guidelines recommend that, if possible, oncologists speak with young adults with cancer about fertility preservation prior to starting treatment, but research shows that oncologists don’t always present all fertility options to their patients with cancer. Therefore it is important for patients to speak with their oncologist about their preferences and plans for having children and ask about their options for fertility preservation prior to beginning any treatment or surgery.
Fertility considerations for women with cancer
Some cancers and cancer treatments, especially gynecologic surgery and radiation and certain chemotherapies, can affect fertility in women. These effects may be temporary or permanent.
The following factors may influence the likelihood of chemotherapy affecting fertility:
- Type of chemotherapy: (e.g.,cyclophosphamide is often is used to treat breast cancer, but it has a high probability of causing infertility).
- Dose of chemotherapy
- A woman’s age and her ovarian reserve (i.e., the quality and quantity of her eggs). Older women have less ovarian reserve and therefore their fertility is more affected by chemotherapy treatment as compared to younger women.
Women who are diagnosed with cancer may have options to preserve their fertility. These options include:
- Menstrual suppression during chemotherapy
- Ovary shielding before radiation
- Egg freezing
- Embryo freezing
Not all experts agree that menstrual suppression protects fertility in premenopausal women who must undergo chemotherapy. Freezing embryos or eggs remains the best method to preserve fertility in women of reproductive age and is the most likely approach to result in pregnancy after cancer. Women diagnosed with cancer who are concerned about their fertility may wish to discuss the following topics with their providers:
- fertility implications before and after treatment.
- contraception after treatment.
- specific methods for fertility preservation such as freezing embryos, eggs, or ovarian tissue.
- medications to suppress menstruation and whether they may protect the ovaries during treatment with chemotherapy.
Fertility considerations for men diagnosed with cancer
Some cancers and cancer treatments, especially those that affect the urologic system, and certain chemotherapies, can affect fertility in men. The following factors may influence the effects of chemotherapy on fertility:
- Type of chemotherapy:
- Dose of chemotherapy
Men who are diagnosed with cancer may have options to preserve their fertility, such as freezing sperm before treatment or surgery. They should speak with their health care providers about their fertility preferences before beginning treatment.
- If you are in your reproductive years and have been diagnosed with cancer, or you are considering steps to lower your cancer risk that will interfere with your fertility, you should request referral to a fertility expert.
- The Oncofertility Consortium maintains a national database of healthcare providers with expertise in fertility preservation and treatment of people who are diagnosed with cancer or at high risk for cancer due to an inherited mutation.
Fertility preservation for women
- NCT03011684: Fertility Preservation Using Tamoxifen and Letrozole in Estrogen Sensitive Tumors Trial (TALES). Letrozole plus gonadotropin and tamoxifen plus gonadotropin are currently used for fertility preservation in patients with estrogen-receptor-positive breast cancer, it is not clear which of the two might lead to improved oocyte yield.
- NCT00823654: Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women with Breast Cancer or Mutations. The purpose of this study is to see how breast cancer treatment affects the ovaries of women with a mutation.
- NCT01788839: Longitudinal Sexual and Reproductive Health Study of Women With Breast Cancer and . The purpose of this study is to see how cancer treatment affects sexual and reproductive function.
- NCT01558544: Cryopreservation of Ovarian Tissue. The study hopes to contribute to the development of technologies of ovarian tissue freezing-thawing the preserve fertility. The study is open to women who will undergo treatment or surgery for cancer or women with an inherited mutation who are considering undergoing risk-reducing surgery.
Fertility preservation for men
- NCT02972801: Testicular Tissue Cryopreservation for Fertility Preservation. Testicular tissue cryopreservation is an experimental procedure where testicular tissue is retrieved and frozen. This technique is reserved for young male patients, with the ultimate goal that their tissue may be used in the future to restore fertility when experimental techniques emerge from the research pipeline.