What are fertility issues?

Quick Answer
Some cancers and cancer treatments pose a risk to a cancer survivor’s fertility. Infertility or sterility can be temporary or permanent.
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Infertility and cancer: For natural conception to occur, men must have at least one testicle that produces enough healthy sperm, the hormones to regulate sperm production, the ability to make semen, and the ability to ejaculate the semen. Women need at least one ovary that makes mature and viable eggs, a Fallopian tube through which the egg can move and be fertilized, a uterus capable of maintaining a pregnancy, and the hormones necessary for ovulation and pregnancy. Chemotherapy and radiation in the course of cancer treatments can damage or kill cells required for production of sperm (sperm stem cells) and immature eggs (oocytes) or mature eggs. These treatments can also affect the production and regulation of hormones required for reproduction. Male and female reproductive structures can be damaged by radiation or removed or damaged by surgery.

Fertility preservation: Infertility can cause a great deal of psychological distress for cancer survivors. It is advised that cancer patients discuss fertility issues with their oncologists and consult a fertility specialist before treatment. Specialists can inform patients of their risk, if known, of becoming infertile after treatment. In some cases, there are fertility preservation methods that can be undertaken before or during treatment. Patients must weigh the costs and benefits as some preservation methods may alter the efficacy of the cancer treatment, especially if the cancer is hormonally sensitive or affects the reproductive organs. Another possibility in some cases is delaying cancer treatments to pursue fertility preservation. Fertility preservation procedures, including long-term storage of sperm, can be expensive. Assisted reproductive technologies can assist in conception after treatment, but not all patients will want to pursue them or be able to pay for them.

Fertility preservation before puberty: Many parents are concerned about protecting a prepubescent child’s fertility from the effects of cancer treatment. Treatments can prevent, delay, or accelerate puberty. The effects on fertility may be permanent or may not be evident until later in life, when they can shorten a person’s reproductive years. Unfortunately, preserving fertility in a child can be a challenge. Fertility-sparing treatment methods that protect reproductive organs from radiation or conservative surgery on reproductive structures may prevent damage to a child’s reproductive systems. Because prepubescent boys and girls cannot make mature sperm or eggs, respectively, researchers are investigating whether testicular or ovarian function can be restored by transplanting back testicular or ovarian tissue that was collected and frozen before treatment.

Parenthood for cancer survivors: Cancer survivors confront many issues when considering parenthood after treatment. Oncologists typically advise waiting two to five years after treatment before trying to conceive naturally or through assisted reproduction technologies. Fertility may improve over time as damage to sperm or eggs is naturally repaired. Some cancer treatments also damage the heart and lungs, which can complicate a pregnancy; therefore, women may benefit from waiting. Oncologists also recommend waiting to see if the cancer returns. The likelihood of reoccurrence affects a person’s decision to become a parent.

When considering parenthood, many survivors have concerns about the possible impact of the cancer or cancer treatments on the health of a baby. Although it has not been studied extensively, the findings to date do not show any increase in birth defects in children born to cancer survivors. Some are also concerned about their children inheriting a so-called cancer gene or the genetic tendency to develop cancer. Genetic counselors may be able to estimate that risk.

Survivors who are unable to conceive a child who is genetically related to both parents still have options for parenthood. A sperm donor can be used to fertilize a partner’s egg. Similarly, donated eggs can be fertilized by a partner’s sperm. In these cases, the child would be genetically related to one parent. Women whose eggs are unable to be fertilized may still be able to carry a pregnancy. These women can use donated embryos created through in vitro fertilization. Survivors may also consider adoption. Many adoption agencies require a letter from an oncologist that the prospective parent is cancer-free and is expected to have a normal lifespan and good quality of life. Some agencies require survivors to be cancer-free for a certain amount of time before being eligible for adoption.

Bibliography

Amer. Cancer Soc. "Fertility and Men with Cancer." Cancer.org. ACS, 6 Nov. 2013. Web. 31 Oct. 2014.

Amer. Soc. of Clinical Oncology. "Having a Baby after Cancer: Pregnancy." Cancer.Net. ASCO, Jan. 2013. Web. 31 Oct. 2014.

Falker, E. S. The Ultimate Insider’s Guide to Adoption: Everything You Need to Know About Domestic and International Adoption. New York: Hachette, 2006. Print.

Lee, S. J., et al. “American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients.” Jour. of Clinical Oncology 24.18 (2006): 2917–2931. Print.

Natl. Cancer Inst. "Sexuality and Reproductive Issues (PDQ(R)): Fertility Issues." Cancer.gov. NCI/NIH, 9 Dec. 2013. Web. 31 Oct. 2014.

Oktay, K. H., L. Beck, and J. D. Reinecke. One Hundred Questions and Answers About Cancer and Fertility. Sudbury: Jones, 2008. Print.