By fertility, we understand the human ability to conceive or have a child. This biological capacity depends on factors such as age, the proper functioning of the reproductive organs, and hormone levels that are not excessively high or low. One of the factors that can negatively impact these functions is cancer and its subsequent treatment aimed at eradicating it.
Below, we will examine how cancer affects individuals during their reproductive years and the opportunities offered by reproductive medicine to address this complex issue.
How Cancer Affects Fertility
Cancer and cancer treatment can sometimes cause serious difficulties in having children. These issues, as noted by the American Cancer Society, may result from:
- A tumor that directly damages an organ or its surrounding tissue.
- The removal of cancerous organs that are typically necessary for having children (for example, cancer surgery may require the removal of part or all of the testicles, penis, ovaries, uterus, or cervix).
- Certain cancer treatments that may alter hormone levels, induce early menopause in women, damage nerves, or impair the proper functioning of sexual organs.
- Psychological or emotional responses, such as stress and anxiety.
Any of these situations may lead to serious fertility concerns once treatment is completed.
The Impact of Cancer During Reproductive Age
Thanks to scientific advances, improved diagnostics, and more effective research protocols, cancer mortality among adolescents has dramatically decreased. In the United States—the country with the most up-to-date data on cancer mortality—current cure rates range from 70% to 90%, and there are now nearly 10 million cancer survivors in the U.S. alone.
At the same time, there are long-term side effects that affect various organs and tissues, including the gonads, which have a direct impact on future reproductive potential—a common late effect of oncological treatments.
Most of these late effects are caused by chemotherapy and radiotherapy.
Effects of Chemotherapy and Radiotherapy
In addition to short-term side effects such as nausea or hair loss during treatment, cancer therapies can have medium- and long-term consequences that affect fertility.
Similarly, certain doses of chemotherapy and radiotherapy may decrease germ cells and cause clinical hypogonadism. As with chemotherapeutic agents, these treatments can induce mutagenic effects on germ cells and teratogenic effects on the fetus.
For instance, radiotherapy directly affects the testicles, which are highly radiosensitive due to the rapid cell division of the tubular epithelium. In women, only general guidelines exist regarding the ovarian threshold for radiotherapy. It is reported that female gonads cease to function when exposed to doses exceeding 150 cGy. Age plays a significant role: women under 20 receiving total nodal irradiation have about a 70% chance of retaining regular menstrual cycles; at age 30, only 20% maintain normal ovarian function; and in older women, virtually all may become sterile.
How to Protect Fertility After Cancer Treatment?
In recent years, there has been increased awareness and scientific research into how to protect the gonads of patients undergoing cancer treatments. Efforts have focused on selecting accurate doses and implementing strategies for germ cell preservation. Assisted fertility programs have played a significant role in supporting these initiatives.
While methods such as gonadotropin suppression, testicular shielding, oophoropexy, and sperm cryopreservation are notable, we highlight the importance of assisted reproductive techniques.
Assisted Reproductive Techniques
The potential to improve fertility arises through in vitro fertilization (IVF); thus, cryopreserved sperm can fertilize more eggs or create embryos suitable for freezing. Assisted reproductive techniques can also be applied to cancer patients before starting chemotherapy or radiotherapy.
When time allows, IVF can be performed to obtain cryopreserved embryos. If estrogen exposure is contraindicated, as in women undergoing treatment for breast cancer, embryos may be flushed from the uterus following several months of natural intercourse and then cryopreserved.
In recent years, two breakthrough technologies have transformed the possibilities for preserving reproductive options in men and women with cancer. These include in vivo fertilization using sperm with intracytoplasmic sperm injection (ICSI) following semen cryopreservation in men, and autotransplantation of gonadal tissue after ovarian tissue cryopreservation in women.
Where Can I Go?
If you are about to begin cancer treatment—or are already undergoing it—and wish to have a child, it is essential to seek out clinics experienced in fertility preservation. Ovoclinic operates its own egg bank, Ovobank. The team of professionals at Ovoclinic, including a multidisciplinary medical staff, is ready to help and guide you through every step of the process. Don’t hesitate—book your consultation today.
References
- American Cancer Society. (n.d.). How Cancer Treatments Can Affect Fertility. https://www.cancer.org/es/cancer/como-sobrellevar-el-cancer/efectos-secundarios/efectos-secundarios-sobre-la-fertilidad-y-la-sexualidad/como-afectan-los-tratamientos-del-cancer-a-la-fertilidad.html
- Ferrell BR, Hassey Dow K. Quality of life among long-term cancer survivors. Oncology 1997; 11: 565-571.
- Neglia JP, Nesbitt ME. Care and treatment of long term survivors of childhood cancer. Cancer 1993; 71: 3386-3391.
- Sherins RJ. Gonadal Dysfunction. In: DeVita, Hellman, Rosemberg. Cancer principles and practice of oncology. 4th ed. Philadelphia: Lippincott, 1993: 2395-2406.
- Opsahl MS, Fugger E, Sherins RJ, Schulman JD. Preserving reproductive function before cancer treatment. New options including sperm and ovarian cryopreservation. Cancer J 1997; 1: 305-308.
