Introduction
Patients with certain cancers or those undergoing treatment for cancer may experience these doubts or fertility problems. The reasons for fertility issues may include:
- An organ related to fertility, or its surrounding tissue, is directly damaged by a tumour
- Removing cancerous organs that are normally necessary for reproduction (for instance, a cancer surgeon might remove part or all of the testicles, penis, ovaries, uterus, and cervix during a cancer surgery)
- It is possible that some cancer treatments can alter hormone levels, cause women to go into early menopause, damage nerves, or prevent certain sex organs from working properly
- Cancer treatment and lack of clarity on resulting fertility issues cause psychological or emotional reactions such as stress and anxiety.
In each of these situations, fertility can be seriously impacted when treatment ends.
Concerns About Birth Defects
Usually, cancer treatment does not affect fertility, but if a pregnancy occurs after or during treatment, there can be concerns about birth defects. A woman’s chances of becoming pregnant may remain high even years after a cancer treatment has ended in some cases. The general recommendation is that women should avoid getting pregnant during and shortly after treatment, depending on their therapy and circumstances.
There is no clear indication of the chances of a man having a child with birth defects after having his treatment. Men undergoing treatment are often advised to use birth control and to not try to conceive whilst undergoing treatment, just in case.
Discuss With Your Health Care Team
It is important to discuss the risks and available options with your health care team when fertility problems are suspected, or there may be risks associated with having a baby after treatment. Unfortunately, during check-ups and treatment visits, doctors, nurses, and other members of a health care team do not always inquire about fertility problems. Therefore, patients are often required to initiate the conversation about it and are more likely to get inadequate information, support, or resources in dealing with their fertility problems.
Any fertility problems that may result from cancer treatment should be discussed with the cancer care team as early as possible, either prior to surgery or before the treatment starts. Conversations about your preferences, religious or personal beliefs, and costs should be considered. Try getting a second opinion or consulting a fertility or reproductive specialist.
For Adult Cancer Patients
It may be important to you to be able to have a child (or another child) depending on your age, your choices, and your family situation. If that is the case, be sure to discuss how your cancer, any surgery, and the treatments you need may affect your fertility with your cancer care team.
Give your team of cancer care providers as much information as possible and ask questions so they can support you as much as they can. However, the most important thing is to discuss your concerns with your partner. If any fertility problems arise during or after treatment, make sure you get as much information as possible so you can decide together how to approach them. Include your partner in your discussions with your healthcare team if you are both comfortable with that.
Having a conversation with others, such as friends, family members, or other cancer survivors, can be beneficial. Remember, however, that everyone experiences things differently, and one person’s experience may be completely different from yours. Treatment or cancer may not affect everyone in the same way. Depending on the type and stage of cancer and treatment, the effect of cancer on fertility can differ. Other health conditions can affect how the body reacts, too.
Counsellors, therapists, and fertility specialists can help you talk about your options and alleviate some fears and worries about how cancer will affect your fertility.
For Child Cancer Patients
Special attention is often paid to children and teenagers who have cancer. The main reason is that they might be subjected to surgeries or treatments that could harm their developing and maturing organs, as well as interfere with their hormones and sexual development. This can affect their fertility later on in life if surgery or treatment occurs while they are still young.
When children, teenagers, and young adults are diagnosed with a disease, it is essential that their parents are informed of the effects on fertility as soon as possible, and before treatment begins. Fertility preservation options might be available depending on the situation.
It’s vital that parents talk with their child’s health care team before starting cancer treatment about the possible long-term effects on sexual development and fertility. Fortunately, some of these effects can be limited or prevented.
Male Sexual Development
The side effects of radiation therapy and chemotherapy can affect sexual development as well as sperm production in boys and young men. A cancer treatment is more likely to damage the testicular cells that produce sperm than to damage those that produce hormones. According to the intensity of the treatment, there may be short-term or long-term effects.
The cells that produce sperm can be affected by radiation therapy for the testicles. Having radiotherapy at a higher concentration could also damage the cells that produce hormones. An abdominal (belly) or pelvic dose of radiation might also have this effect. It is sometimes possible to shield or move the testicles out of the radiation field during treatment to prevent this.
Due to the pituitary gland’s influence on sex hormone levels in the body, radiation therapy to the head area can also affect sperm production and sexual development.
Certain chemotherapy drugs have a greater likelihood of affecting sperm-producing cells in high doses, but high doses can have an adverse effect on hormone-producing cells as well.
The ability of a patient to father children can be affected by treatments that affect sperm production. Some may only experience it for a short time, while others may experience it long-term or even permanently. Before starting cancer treatment for an older child, it is important to consider this. Boys who have completed puberty may be able to father children later in life by sperm banking (collecting and freezing sperm samples). In boys who are treated before puberty, there is less risk of effects on fertility.
Female Sexual Development
Women’s ovaries and womb (uterus) play an important role in sexual development and pregnancy. Cancer treatments can affect these organs.
Radiation therapy and chemotherapy can both affect the ovaries. When girls are treated, their age and stage of puberty determine the risk of complications. It is less common in girls who have not yet experienced puberty.
When radiation is applied to the abdomen or pelvis, the ovaries can be damaged. Therefore, protecting the ovaries during radiation treatment is important. The pituitary gland can also be affected by radiation to the head, which can interfere with the hormones required by the ovaries for them to work optimally.
Chemotherapy drugs taken in high doses can damage the ovaries. Menstrual periods may become irregular or stop in girls who are already menstruating, which may be temporary or long lasting. The side effects of some chemo drugs (and lower doses of chemo) are less common.
When a girl receives treatments that affect her ovaries, she is at risk for early puberty and menstruation, irregular periods, early menopause, reduced fertility, and other health problems. Some of these issues can be treated with hormone replacement therapy if they persist after cancer treatment.
Radiation may affect the uterus, too, especially if the abdomen is irradiated. Some late effects can be enlarged uteruses or uteruses that do not stretch as they should during pregnancy. Premature births, low birthweight babies, and miscarriages can result from this condition.
Childhood Cancer Survivors
Survivors of childhood cancer may wonder whether they can have children. They usually can have healthy children, although some risks may exist.
Low sperm counts or other problems may affect the fertility of men who are cancer survivors. Fertility problems may come in the form of irregular menstruation, early menopause, or changes in the uterus in women. Some of these conditions have been discussed earlier. It is important to carefully monitor patients both during and after treatment for any problems that may occur.
It may be possible for some whose cancer was treated as children to preserve their fertility or increase their chances of having their own children later in life. Some older boys may be able to bank sperm before treatment if they wish. Trying to get pregnant early in a woman’s childbearing years may improve women’s chances of having a successful pregnancy.