How can cancer treatment affect fertility in women?

  • Stopping you from producing certain hormones that are essential for the production and maturation of eggs in the ovaries

  • Stopping your ovaries from working

  • Damaging the lining of your Uterus

  • Involving surgery to remove your Uterus


Understanding stages of fertility

It is important to be aware that immediately after treatment it can be difficult to know the impact on your fertility. The four possible outcomes are often described as:

Normal Fertility

Many women who undergo cancer treatment have no change in their fertility and are able to have a baby naturally.

Fertility Followed by Early Menopause

Many cancer treatments damage some, but not all, of the eggs in your ovaries. This means that you may have a period of time when you are fertile after cancer treatments and then go into early menopause.

Compromised Fertility
This can happen from damage to the ovaries, hormone production or reproductive system. This damage can make natural conception hard, but pregnancy may be possible with help from a fertility doctor.

Immediate Menopause
This can happen if your eggs are damaged or destroyed by your cancer treatments and/or your reproductive organs are damaged or removed.

If there is time before your treatment, referral to a fertility specialist can provide more information about your options, this is something your doctor will be able to advise you on.

The success rate for fertility preservation techniques is difficult to assess, but we do know that it is low. This is something that you should take into account before making a decision, particularly if it might result in a delay to your treatment.


COMMON WAYS TO PRESERVE FERTILITY IN WOMEN

The two main options for women are:

1. Embryo Freezing (Cryopreservation)

  • This involves going through the process of IVF.
  • It is the most successful method of fertility preservation.
  • As mentioned above, there are a huge number of variables that affect the success; the OncoFertility Consortium in the USA does provide some more information on this here.
  • Once an embryo is frozen, it can be stored for up to 10 years.

2. Egg Freezing (Cryopreservation)

  • This involves the same process as above, without fertilisation of the eggs. You will still be treated with a fertility drug to inhibit your own cycle for 2 weeks, followed by a hormone known as gonadotrophin, to stimulate the production of lots of eggs. Theses eggs will be collected, as they would for IVF, by using ultrasound scanning to pass a needle into the ovaries.
  • Once frozen, these eggs can also be stored for up to 10 years.
  • Both of these techniques involve the use of hormone therapy which can increase oestrogen levels.
  • For women with hormone sensitive cancers it is important to talk about the risks with your oncologist; you may be offered drugs called ‘aromatase inhibitors’ to keep the levels of oestrogen lower.


LESS COMMON FERTILITY PRESERVATION TECHNIQUES FOR WOMEN

Below are other possible fertility preservation techniques, some that are currently experimental and others that depend on the type and location of your cancer; if you have any more specific questions you can bring them up with your own oncology team.

1. Shielding During Radiation

  • During radiotherapy treatment a shield may be used to reduce the radiation to the ovaries.
  • Whether or not this technique can be used depends on the area of the body that the radiation needs to reach in order to treat your cancer.

2. Ovarian Transposition (moving the ovaries)

  • This is the surgical repositioning of the ovaries away from the radiation field.

3. Trachelectomy (surgical removal of the cervix, only for cervical cancer)

  • In this type of surgery the cervix and the upper part of the vagina are removed, but the rest of the uterus (womb) is left in place. Trachelectomy is only suitable for some women with early-stage cancer of the cervix.

Experimental Techniques

1. Ovarian Cryopreservation and Transplantation (freezing tissue from the ovary)

  • Part or all of an ovary is removed through a surgical procedure. Removed tissue that contains hormone-producing cells and immature eggs is divided into strips and frozen for future use.
  • This is a new procedure and the likelihood of it leading to a success is slim.

2. Ovarian Suppression

  • Taking hormones to suppress ovarian function, to protect the eggs from treatment.
  • The effectiveness of this procedure has not yet been demonstrated.

Check out Fran's story on our Young Adults stories about how cancer affected her fertility.