A Guide to Fertility and Cancer

Having children is a personal decision for every couple. For those who also face cancer, these decisions may become more complicated or have to be faced sooner rather than later. Preserving fertility or fertility treatments may be complicated, expensive and emotionally trying for both members of the couple. We have put together the following information to help you understand the effect your cancer or its treatments may have on your ability to have children in the future and what options you have now.

Fertility is the ability to conceive a child, donate healthy sperm or a healthy egg, and the ability of a woman to carry a pregnancy to term. Cancer, or its treatments, may cause temporary or permanent infertility. The American Society of Clinical Oncologists has issued a set of guidelines in order for the physicians and nurses who treat cancer patients to provide information that addresses any concerns that may arise before, during or after your treatment at Roswell Park.

For both men and women, problems with fertility can arise from surgical removal of reproductive organs, damage to the reproductive ability from surgical, radiation, or chemotherapy treatments, or interference with the hormonal functions that normally allow fertilization and pregnancy to occur and continue to a live healthy birth.

Keep in mind that some options are still under investigation, so they may not be available, and other options may not be available because of the type of cancer or treatments that you will need to undergo. If you are concerned with preserving your ability to have children in the future, discuss these concerns with your physicians and nurses as soon as possible. Some options may only be available before your treatments begin.

Your Options Before Cancer Treatment

  • Women can have eggs taken, called harvesting, fertilized “in vitro” by a sperm, and the resulting embryos frozen for later use. This process is called embryo cryopreservation.
  • Women who will be receiving radiation treatment may have their ovaries temporarily moved out of their normal position in the pelvic area, thereby sparing the ovaries from the effects of the radiation.
  • Women may take certain hormonal therapy that shuts down their monthly hormonal cycle that usually results in the release of an egg during the normal menstrual cycle, which can protect the tissue of the ovary.
  • Two investigational methods for women are oocyte cryopreservation, a process in which the egg is collected and frozen for later use, and ovarian tissue cryopreservation, a process in which ovarian tissue is frozen so it can be replanted after your cancer treatments are over.
  • Men can have their sperm frozen and banked for later use (sperm cryopreservation)
  • Two investigational methods for men include the use of hormonal therapy to protect testicular tissue during chemotherapy or radiation (hormonal gonadoprotection), and removing, freezing and storing testicular tissue to be surgically implanted after cancer treatment, a process called testicular tissue cryopreservation.

How to Begin

  • Talk with your healthcare team at Roswell Park about your individual circumstances regarding the type and stage of your cancer and your proposed treatment regimen. Not all treatments affect fertility.
  • If your cancer or treatment may affect fertility and this is causing you anxiety, ask your doctor or nurse for referrals for counseling or other support services – many of which are included in this pamphlet.
  • Ask your doctor if you should consult with a reproductive endocrinologist, a physician whose expertise is in preserving fertility.

How Cancer Can Affect Fertility

Your cancer may directly involve:

  • organs or tissues that are essential to sperm production and movement in men
  • the normal menstrual cycles in women • the organs that deliver sperm
  • the organs that carry the egg from the ovary to the uterus
  • the uterine environment necessary to maintain a pregnancy
  • the vaginal orifice for the normal methods of sperm delivery
  • the hormones necessary in both men and women for the production of eggs and sperm, or the maintenance of a pregnancy.

Certain cancers may also have an affect on the necessary nerve or blood supplies to these organs and tissues.

How Cancer Treatments Can Affect Fertility

Radiation is a local therapy, meaning it affects only those areas that are in the radiation field area. External radiation, however, can damage the tissues near the area of cancer. Radiation therapy has become quite sophisticated in targeting cancerous tissues, but sometimes damage to adjacent structures cannot be avoided without compromising the effectiveness of the treatment. Though external radiation does not make you “radioactive, scarring of normal tissue may result. Internal radiation, called brachytherapy, involves placing radioactive substances directly into the body for a limited amount of time, during which they would emit a certain amount of radiation. If you will have this type of treatment, your doctor and nurses will explain any precautions that should be taken to protect those around your while you have the radioactive implants.

Chemotherapy is a systemic therapy, that is, the drugs used will travel throughout your body. Certain drugs used for chemotherapy can cause temporary or permanent infertility by causing damage any of the intricate processes involved in sperm production, the ability of a man to deliver healthy sperm, release of eggs from the uterus, fertilization of the egg by the sperm, implantation of the fertilized egg into the uterine wall, maintaining the healthy uterine environment that enables an embryo to develop into a healthy fetus and baby, or a woman’s ability to deliver a healthy child.

Certain treatments may cause early menopause, a condition in which a woman’s normal menstrual cycles cease.

The “Grey Areas”

Often, your doctors may not be able to give you an absolute answer that you will or will not be infertile after your treatments. Sometimes infertility is temporary for some, but not others. Your doctors will give you’re the best information they can based on their training, knowledge, and your personal circumstances, but still nature may give you an unexpected outcome. While this may mean you will face infertility when it was not expected, or it may also mean an unexpected pregnancy.

Cancer, or its treatment, may also cause decreased fertility meaning that your chances of having children will be lessened. Reproductive endocrinologists can assist couples that find themselves in this circumstance and explain all the current options available to increase your chances of having children, if that is what you desire.

Resources for Information and Support

Fertile Hope, a partnership organization with the Lance Armstrong Foundation: Toll free number is 888-994- HOPE (4673). This is a nonprofit organization dedicated to helping cancer patients faced with infertility.

People Living With Cancer (PLWC) is an oncologist-approved cancer information website from ASCO. The information is presented in English or Spanish, illustrations help you understand how cancer and treatments affect your body, a chat line is available, as is the latest cancer news and information on managing side effects. Toll free number is 888-651-3038.

ASCO: This site is aimed at oncologists, but has valuable information for those who are more medically- oriented. It also has links to the PLWC website.

CancerCare: Toll free number is 800-813-HOPE (4673). CancerCare is a national nonprofit organization that provides free, professional support services for anyone affected by cancer. This site is available in English or Spanish.

Lance Armstrong Foundation: Number is 512-236-8820. This organization offers information and services to help cancer survivors live life on their own terms.

The Susan G. Komen Breast Foundation: Toll free number is 800-I’M AWARE (800- 462-9273). A nonprofit organization for survivors and those facing breast cancer.

Pregnant With Cancer: A national non-profit organization for women diagnosed with cancer during pregnancy whose mission is to connect women who are pregnant with cancer with other women who have been pregnant with the same type of cancer.

Local Resources for Information and Support

The Infertility and Invitro Fertilization Medical Associates of Western New York. Services include: infertility evaluation and treatment; computerized semen analysis; In Vitro Fertilization (IVP); Intracytoplasmic Sperm Injection (ICSI); donor sperm insemination; endometriosis surgery and treatment; tubal ligation reversal; and surgical treatment of uterine fibroids. They are located at 4510 Main Street, Snyder, NY 14226. Phone number is 839-3057.

Local chapter of Pregnant with Cancer Network. PO Box 1243. Phone number 800-743-4471. Periodic publication is called “Hopeline”.

Financial Support

Sharing Hope is a program from Fertile Hope to help increase access to egg, embryo and sperm freezing for newly diagnosed cancer patients whose medical treatments present the risk of infertility. They provide discounted sperm banking services, access to fertility medication, and discounted egg and embryo freezing services.

Pamphlets with specific information about the procedures mentioned here and the organizations and services listed can be found in the Community Cancer Resource Room, located on the first floor of the hospital inside the cafeteria (near the cashier).