Cancer and fertility

Thanks to better medicine and testing, more and more young Canadians diagnosed with cancer survive. Many people lead normal lives after overcoming their disease. But life-saving cancer treatments can affect fertility.

The good news is cancer patients who want to have their own children now have ways to preserve their fertility and to improve their chances of having a baby after cancer treatment. To have the most options, it is best to let your doctor know before you start your cancer treatment that you want to try to preserve your fertility.

Fertility risks

Some cancer treatments are more likely to cause infertility than others. Chemotherapy, radiation, and surgery can all cause infertility, depending on the type, dose, length, frequency, and location of treatment.

• Chemotherapy risks: Certain types of chemotherapy can cause permanent damage to eggs and sperm.
  
• Radiation risks: Whole body or abdominal/pelvic radiation can cause infertility in women and men by causing irreversible damage to the eggs or sperm cells. For women, radiation of the pelvic area often causes damage to the uterus, making a woman unable to conceive or maintain a pregnancy.
  
• Surgery risks: Surgery to treat cancers of the reproductive system may cause infertility, especially if organs like the testes, uterus, or ovaries are removed.

Ways to preserve your fertility

Here are some options for preserving your fertility. Please talk to your doctor for more guidance and information on your individual situation.

Women

• Egg freezing: Freezing one or more of your egg(s).
• Embryo freezing: Freezing one or more embryo(s) (the product of an egg fertilized by sperm).
• Ovarian shielding: Protecting your ovaries and/or uterus from radiation using a shield to reduce damage.
• Ovarian tissue freezing: Removing part or all of one of your ovaries in order to freeze it for later.
• Ovarian transposition: Using surgery to reposition one or both of your ovaries away from the radiation field.
• Trachelectomy: Using surgery to remove your cervix, leaving your uterus intact for a possible future pregnancy. This is a common treatment for early stages of cervical cancer.

Men

• Sperm freezing: Freezing your sperm so that you can use it at a later date.
• Testicular shielding: Protecting your testicles and/or pelvic area from radiation using a shield to minimize the risk of damage.
• Testicular tissue freezing: Removing and freezing tissue from your testicles. This procedure is experimental with no live births to date, but shows promise for the future.

Fertility options for cancer survivors

Here are some options for becoming pregnant after cancer treatment:

• Natural conception: Many women that have survived cancer are able to become pregnant naturally after cancer treatment. Blood tests and ultrasounds that measure hormone levels and ovary activity can help determine your odds of success. If you are a man who has survived cancer, you can have your sperm tested to see if natural conception will be possible.
• Assisted reproduction: There are ways to preserve your eggs or sperm, conceive, and become pregnant.
  • Before undergoing cancer treatment where fertility may be at risk, women may want to freeze their eggs and men may want to freeze their sperm.
  • Egg freezing is a new practice that is quickly evolving. While it is not as well established as sperm or embryo freezing, it has become an increasingly successful form of fertility preservation for women.
  • Where a woman’s eggs may be damaged by cancer treatment, the couple's egg and sperm could be used before treatment to create in vitro embryos that could then be frozen for later use.
  • For men that are cancer patients, frozen sperm could be used to achieve pregnancy through intrauterine insemination (IUI) or in vitro fertilization (IVF).
• Donor eggs/sperm/embryos: If you become infertile because of cancer treatments, you may choose to use donor egg(s), sperm, or embryo(s).
• Surrogate mother: A surrogate mother (also called a gestational carrier) is a woman who carries a pregnancy to term on your behalf. This is an option for a woman who has had radiation on her pelvis or abdomen, causing damage to her uterus and/or ovarian failure (making it hard to get pregnant or carry a pregnancy).
• Adoption: Some private agencies may consider medical history as a factor in adoption.

You can explore your fertility options more with a reproductive endocrinologist (a doctor who specializes in fertility and reproduction).