By MD, PhD (gynecologist) and BSc, MSc (embryologist).
Last Update: 03/05/2019

The appearance of tumor or cancer is one of the worst experiences in people’s lives. At this point, they must begin a hard path and undergo cancer therapies necessary with the sole aim of healing and being able to move on with their lives.

However, some of these people who have had some form of cancer and have managed to overcome it must face another concern:the infertility derived from cancer treatments.

Today, assisted reproduction and fertility preservation programs allow these affected people to fulfil their dream of becoming parents.

The different sections of this article have been assembled into the following table of contents.

Effects of oncological treatment

Chemotherapy and radiation treatments to fight cancer can affect male and female fertility, causing both temporary and permanent infertility.

However, the risk of infertility and not being able to have a child naturally will depend on a number of factors:

  • Type of tumor, stadium and location
  • Age and sex of patient
  • Type and dosis of drugs used in chemotherapy
  • Dosis of radiation and parts of body at which radiotherapy is applied
  • Stadium of fertility before cancer therapy

The types of cancer that can most affect male fertility are testicular cancer, prostate cancer, leukemia, and Hodking’s lymphoma.

In terms of female fertility, the most relevant types of cancer are breast cancer, cancer of the uterus or cervix, ovarian cancer and lymphomas.

That is why the American Society for Clinical Oncology (ASCO) recommends that all individuals who are initiating oncology treatment talk to a member of the medical care team about the effects on their fertility and whether there are fertility preservation options that are compatible with such treatments.

Masculine infertility

Chemotherapy aims to kill rapidly dividing cells in the body, such as tumour cells.

However, males have other cell types with rapid division: sperm. This makes both sperm and spermatogonies (testicular stem cells) easy targets for antitumor drugs.

On the other hand, the high-energy rays used in radiation therapy to destroy cancer cells can also affect these sperm-producing stem cells, especially if the radiation is directed at the testicles.

The type of infertility that men can suffer once the cancer is over, temporal or permanent, will depend on the damage caused to the spermatogonial stem cells of the testicles. If they are severely damaged, they will not be able to divide further and produce new sperm.

In addition, radiation therapy may also affect the brain, specifically the hypothalamus and pituitary gland, and alter the entire hormonal production that regulates spermatogenesis. This would also result in a drop in sperm production and sex hormones such as testosterone.

Female infertility

In women, the main consequence of oncological treatments is the decrease in ovarian reserve, especially in the case of radiotherapy in the pelvic area.

In these cases, age is a crucial factor. The younger a woman is, the more likely she is to keep a small part of her eggs after overcoming cancer.

However, it should be noted that all women who have received chemotherapy or radiation therapy are prone to premature ovarian failure or early menopause.

On the other hand, radiation directed at the uterus can also cause damage that prevents the embryo from being implanted in the endometrium or stretched during gestation, leading to miscarriages or premature babies.

As with men, cancer therapies can also affect the hypothalamus-pituitary-ovarian axis and cause menstrual cycles to maladjustment.

Fertility preservation

Many of the fertility alterations discussed throughout this article may have a solution if the person affected by the cancer makes the decision to preserve his or her fertility.

This is why it is essential to consult a specialist before receiving cancer treatment.

In men

The options men have to preserve their fertility are discussed below:

Freezing of semen
this is the best option because it is very simple, it is just necessary to collect a semen sample per masturbation. If the male enjoys good semen quality, it would even be possible to attempt pregnancy with artificial insemination. The most important thing is to realise it before initiating the oncological treatment, otherwise there would be risk of producing genetic damage to the sperm.
Cryopreservation of the testicular tissue
this is a method still under investigation which consists of the extraction, the freezing and storing of the testicular tissue, which later can be reimplanted in order to reestablish fertility by undergoing oncological treatment. In case of the children who have still not reached puberty, this is the only option to preserve fertility.

If you are considering preserving your fertility to have a baby in the future, we recommend that you start by getting a Fertility Report. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

In women

Regarding women there are various alternatives although some of them are more complicated or are currently in an experimental period.

Ovule vitrification
consists of ovarian stimulation to obtain and freeze ovules. Later, these can be used in an in vitro fertilization treatment to achieve pregnancy. It should be noted that this process requires a certain amount of time, which not many patients dispose of before starting chemotherapy or radiotherapy. Furthermore, in the case of hormone-dependent tumours, ovarian stimulation could lead to a worsening of the cancer.
Ovariopexy or transposition of ovaries
in order to prevent damage, Ovaries are surgically transferred to a different place of the body, away from the area which is being affected by the radiotherapy.
Preservation of ovarian tissue
a portion of the ovarian cortex, where the preanatal follicles are found, is surgically obtained and frozen and placed back into the body after cancer treatment. This procedure is in its experimental stages, especially for girls with cancer who have not yet reached puberty and are therefore unable to vitrify their eggs.
Oocyte in vitro maturation
is the collection of immature ova from the ovary and their subsequent maturation in the laboratory so that they can later be used for in vitro fertilisation treatment. It is used in cases where there is no time or ovarian stimulation is not possible.
Ovarian suppression
experimental method involving the use of GnRH agonist hormones to stop the ovaries from functioning. Current research suggests that this is not a good option for protecting fertility during cancer treatment, but clinical trials continue.

FAQs from users

How do treatments such as chemotherapy or radiation therapy affect a person’s fertility?

By Juan Antonio García Velasco MD, PhD (gynecologist).

It has been known for years that cancer treatments damage the male and female germ line. Until recently, the priority in the face of cancer was to be cured. Due to the great advances achieved in the treatment of cancer and the high survival rates that are obtained today in some types of tumours, the importance of controlling the side effects of these treatments is gaining ground. One of them is infertility and, although men have been able to store sperm from the ejaculate for years, today women can also freeze eggs and ovarian tissue.

For many cancer patients it is necessary to preserve fertility. When should this decision be made?

By Juan Antonio García Velasco MD, PhD (gynecologist).

The approach must be prior to the start of chemotherapy or radiotherapy, otherwise it will be too late to do anything. Therefore, adequate information on the part of your oncologist is a matter of priority, as it will depend on the type of tumour, the type of oncological treatment to be used, the patient’s age, the time available, etc.

What possibilities does reproductive medicine offer for preserving fertility in cancer patients?

By Juan Antonio García Velasco MD, PhD (gynecologist).

Nowadays, men can freeze semen as they did years ago, with a very good chance of success if this semen is used in inseminations or in vitro fertilization.

Women can opt for two options: a) freezing of ovarian tissue, which requires surgery to remove part or all of the ovary, and freezing this tissue in small fragments, to be re-implanted once the cancer has been cured, or b) freezing of oocytes, which requires a period of 2 weeks to be able to carry out ovarian stimulation and remove the oocytes as is done in conventional in vitro fertilization, but with a very specific medication protocol to avoid harmful effects on hormone-dependent tumours.

How should one act or what guidelines can be followed in the case of cancer in a patient of reproductive age?

By Juan Antonio García Velasco MD, PhD (gynecologist).

There are indeed medical practice guides of scientific societies, where in a consensual way they try to establish the behaviors or offered treatments in those cases, and to inform objectively about the advantages and disadvantages, as well as what is not known about these issues. Specifically, and in Spain, the Spanish Fertility Society has a group that is working precisely on this consensus document.

If cancer occurs in a pregnant woman, what are the chances of treating the disease during pregnancy?

By Juan Antonio García Velasco MD, PhD (gynecologist).

If cancer is diagnosed once the woman is pregnant, the options will obviously depend on the type of tumor and the treatment needed (Surgery? Chemotherapy? Radiation therapy? Combinations?).

There are many cases treated, but it is true that in the first trimester of gestation there is a great risk of abortion and even malformations, and when it occurs in the third trimester, of premature birth, but in this case the collaboration of the multidisciplinary team that weighs the risks and benefits of the decision to take is fundamental.

By Juan Antonio García Velasco MD, PhD (gynecologist).

Once cancer has been treated, the male may be fertile. If this is not the case, he may resort to using the sperm he had frozen before his treatment. In these cases, since the semen is very valuable because of its scarcity (only one or two frozen samples), ICSI is used directly, since gestation can be achieved with a single spermatozoon. Thus, if more children were desired, there would still be a frozen sample.

Suggested for you

If you are interested in finding out more about how to preserve fertility in the face of cancer or other reasons, we recommend that you read on here: Fertility Preservation – Cost & Options for Retaining Your Fertility.

On the other hand, it is possible for cancer to appear during the gestation period, which has an increased risk for both mother and baby. You can read more about this here: Cancer during Pregnancy – What to Expect.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Oktay K, Harvey BE, Partridge AH, Quinn GP, Reinecke J, Taylor HS, Wallace WH, Wang ET and Loren AW. Fertility Preservation in Patients with Cancer. DOI: 10.1200/JCO.2018.78.1914

American Society of Clinical Oncology. ASCO Recommendations on Fertility Preservation in Cancer Patients: Guideline Summary. J Oncol Pract. 2006;2(3):143-146.

Metzger ML, Meacham LR, Patterson B, et al. Female reproductive health after childhood, adolescent, and young adult cancers: Guidelines for the assessment and management of female reproductive complications. J Clin Oncol. 2013;31(9):1239-1247.

Nieman CL, Kazer R, Brannigan RE, et al. Cancer Survivors and Infertility: A Review of a New Problem and Novel Answers. J Support Oncol. 2006;4:171-178.

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Authors and contributors

 Juan Antonio García Velasco
Juan Antonio García Velasco
MD, PhD
Gynecologist
Graduate in Medicine from the Complutense University of Madrid. Intern specialist at Obstetrics & Gynecology at La Paz Hospital, 1992-1995. Graduate in Medicine and Surgery from the Autonomous University. Subspecialist in Assisted Reproduction from Yale University (USA). Main Lecturer of Gynecology at the Rey Juan Carlos University of Madrid. More information about Juan Antonio García Velasco
License: 282842556
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV

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