Cancer and fertility

Cancer patients of childbearing age are often worried about their possibilities to have children after undergoing treatment for cancer. The issue is increasingly topical because nowadays a greater proportion of people who have cancer in their childhood or youth recover from the disease.

Cancer treatments can affect the fertility of those with the disease.

Chemotherapy (cytotoxic drugs or cytostatics) can damage the functioning of the ovaries and testes. Radiotherapy can also harm the ovaries and testes, if the treatment is administered to the pelvic or lower abdominal area, or to the whole body. In some cases, even radiotherapy directed at the head can affect hormonal function. If a patient is given both radiotherapy and chemotherapy, the impact on the gonads can be even more severe. Cancer surgery on the ovarian or testicular areas can also reduce fertility.

In performing treatments, every effort is made to safeguard the fertility of patients. This is not always possible, however. The older a patient is, the slower the recovery from heavy courses of treatment. Of course fertility in adults declines naturally over time anyway.

It is good to discuss with your doctor about the post-treatment chances of becoming pregnant before you begin receiving treatment.

If it is not possible to retain your fertility, parenthood may remain an option using donated gametes or embryos, or by adoption or foster parenting.

It is not advisable to try to have children while you are undergoing or immediately after cancer treatment.

Fertility preservation for women

The functioning of the ovaries can be undermined or cease prematurely as a result of certain forms of cancer therapy. This may jeopardise the chances of women becoming pregnant following cancer treatment. A woman’s fertility timespan may become shorter and the onset of menopause be brought forward.

Heavy treatments may void the whole oocyte reserve. This causes sex hormone deficiency and infertility. But the disruption to your ovarian function may also be temporary, with fertility being restored after a while.

The younger you are, the better your ovaries will withstand the side effects of cancer treatments and the less severe the impact of treatment on your subsequent fertility.

Measures to preserve fertility should be initiated before starting cancer treatments. Your oncologist will estimate, based on your age, state of health and the type cancer treatment, whether it is probable that your fertility will be at risk.

If the assessment is that your fertility may be undermined or lost altogether, you can consider options for harvesting and freezing ova, embryos or ovarian tissue. It is not always possible to take fertility preservation measures, though, for example if cancer treatment must begin immediately or if a patient’s ovarian function is already compromised. It is always best to go for counselling and advice.

Fertility preservation for men

Some forms of cancer treatment can diminish male fertility. Treatments may weaken testicular sperm production or stop it completely. Male fertility can be partially or fully restored following treatments. Permanent or long-term spermatogenesis disorder happens if cancer treatment affects testicular stem cells.

Fertility preservation measures should be initiated before starting cancer treatments. Your oncologist will be able to estimate, based on your age, state of health and the type of cancer treatment, whether it is probable that your fertility will be at risk.

Efforts to preserve male fertility can include harvesting and freezing semen or testicular tissue before the start of cancer treatments. It is not always possible, however, to initiate male fertility preservation measures.

Fertility preservation for children and youth

The fertility of most children and youth with cancer remains good following cancer treatment. Some treatments may nevertheless interfere with the hormonal function and fertility of a young person with cancer. In certain situations puberty may be slowed down or missed altogether. In boys, sex hormone secretion may remain normal even though sperm production is disturbed. Then puberty will take place normally but without the formation of sperm.

The impact of cancer treatment on fertility is different for boys and girls. In addition, the effects on fertility depend on the age of the patient (whether or not puberty has started) and the sort of treatment administered.

If it is estimated that cancer treatment will cause infertility, it is possible to try fertility preservation measures before initiating treatment.

The available options depend on

  • the child/young person’s age
  • the stage of physical and psychological development of the adolescent
  • the underlying disease
  • how quickly cancer treatment must be started.

A young adolescent can be considered for the same fertility preserving measures as an adult cancer patient. Prepubescent children cannot yet produce mature gametes. For them the only potentially fertility-preserving procedure is the harvesting and freezing of gonadal tissue (testicular or ovarian). Sometimes there is the option of carefully protecting genitalia during radiotherapy. These measures increase a child’s chances of becoming a parent at a later stage, but they do not guarantee it.