Cancer Treatment and Female Fertility Preservation

Cancer treatment and female fertility preservation at a glance

  • Certain cancer treatments, such as chemotherapy, surgery, radiation and bone marrow transplants, can decrease female fertility.
  • Cancer treatments may affect fertility due to side effects that reduce ovarian function.
  • Women facing such treatments may have the option of fertility preservation, which includes freezing eggs or embryos created through in vitro fertilization (IVF) for future use.
  • As a general rule, the cancer treatment should take precedence over fertility preservation methods.
  • A cancer specialist in consultation with a reproductive endocrinologist will be able to determine if fertility preservation methods performed before the cancer treatment might be appropriate.

How do cancer treatments affect female fertility?

Fertility is an important consideration for women with cancer who wish to have children in the future. How a cancer treatment affects female fertility depends on the treatment and what part of the body is being targeted for treatment.

The organs most in need of protection against cancer treatments are the ovaries. If a woman’s ovaries, the reproductive organs responsible for producing eggs, are damaged during cancer treatment, her fertility may be compromised. Gynecological cancers (endometrial and uterine) that spread to the ovaries will usually require a woman to forgo fertility and future pregnancy.

Cancer treatments can also affect hormone levels that are essential for proper reproductive function.

Some cancer treatments require the surgical removal of the ovaries. Others remove the uterus (hysterectomy), and for those women fertility preservation would involve IVF to create an embryo that would be implanted in the future into a surrogate to carry the pregnancy.

Fertility preservation before undergoing cancer treatments

Women who are undergoing cancer treatment but wish to have children in the future may want to consider fertility preservation techniques.

  • Embryo freezing preserves a woman’s fertility by creating an embryo through IVF before treatment. The creation of an embryo requires sperm, so for women without a partner this may not be an option.
  • Egg freezing also preserves fertility. This involves retrieving the woman’s eggs before cancer treatment then using those eggs in the future in IVF to create the embryo and transfer it to her uterus.
  • Ovarian transposition is a surgical procedure that moves the ovaries away from the field of radiation. This is not used when chemotherapy is also part of the treatment.
  • Gonadal shielding places a shield over the woman’s pelvic region to protect her reproductive organs from the field of radiation. This is not used with chemotherapy.
  • Ovarian cryopreservation, currently classified by the American Society for Reproductive Medicine as an experimental procedure, reserves ovarian tissue prior to cancer treatment. The ovarian tissue is transplanted near the fallopian tube when the woman is healthy. This is an option for women who can’t utilize other fertility preservation methods, for those who can’t delay cancer treatment to have their eggs retrieved, and for girls who have yet to ovulate.

The larger consideration with cancer treatments and female fertility is striking a balance between timing cancer treatments and timing fertility treatments. Some cancers should not wait to be treated even if a woman wants to get pregnant. A fertility specialist will discuss options and recommendations with patients based on their case.

Do fertility medications increase cancer risk?

The relationship between fertility medications and cancer is difficult to research because factors that are known to increase cancer risk are much harder to control for in infertile populations. For example, many women taking fertility medications experience endometriosis or anovulation, conditions that are known to increase cancer risk. Additionally, very few patients develop cancer making a cause-and-effect link difficult to establish.

According to the American Society for Reproductive Medicine’s analysis of existing research, infertile women may be at an increased risk of developing ovarian, endometrial and breast cancer, but there is no evidence to suggest that fertility medications increase this risk.

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