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Fertility and Cancer

Thanks to advances in cancer treatment, more child and young adult cancer patients than ever before have become cancer survivors. However, patients who undergo cancer treatment before they complete their family face the possibility of infertility. Long-term trends of having children later in life has led to a growing number of patients with special concerns about fertility after cancer treatment. Those considering certain treatment options may wish to explore fertility preservation strategies.

Statistics 

  • The average age at which an American woman begins her family has increased from 21.4 years in 1970 to 26.3 years in 2014.
  • Men over age 40 are less likely to regain fertility after cancer treatment. 
  • Women treated for cancer before age 35 have a better chance of conceiving after treatment. 
  • Sperm production slows or ceases after chemotherapy treatment. It usually resumes within one to four years, but can take up to 10 years to return, reducing the likelihood of returning at all.  
  • Chemotherapy, surgery, and radiation therapy can decrease fertility in both males and females.
  • Women treated for cancer are at risk for infertility and early menopause.

Information for Men 

Men treated for cancer will find that the effects of treatment on their fertility vary by the type and dosage of treatment chosen, age at treatment, and the location of their cancer. Some treatments will impair fertility temporarily, and the effects of others will be permanent. Generally, men are advised to wait two to five years before trying to father a child.

Fertility Preservation Options for Men 

For men whose fertility may be impaired by treatment, one of two options for fertility preservation may work for them. For men who have gone through puberty, freezing and banking sperm is the standard recommendation for fertility preservation. For boys who have not yet gone through puberty, there are ongoing studies into procedures that address infertility through freezing and re-implanting healthy testicular tissue, called testicular tissue cryopreservation.

Information for Women 

While pregnancy after cancer does not raise the risk of recurrence, women are advised to wait at least six months before trying to conceive, depending on their type and stage of cancer, as well as the treatment method. Some physicians suggest waiting two to five years. Additionally, women who have undergone radiation, certain chemotherapy treatments that cause the heart to work harder during pregnancy and delivery, or certain surgical procedures to reproductive organs may face difficulties with pregnancy, labor, and delivery. Women who have undergone these treatments should consult an obstetrician who specializes in high-risk cases.

Cancer Treatment During Pregnancy 

Cancer can be treated during pregnancy, though certain accommodations may be necessary. Often, treating cancer in the second or third trimester is less harmful to the baby than an early delivery. After the first trimester, chemotherapy is generally not harmful to the baby, but radiation can increase risk of birth defects. Each pregnant woman’s treatment plan will be unique to her cancer and should balance the mother’s health with her baby’s health. Breast feeding during cancer treatment can pass medications to the baby and is not recommended.

Fertility Preservation Options for Women 

For women whose fertility may be impaired by treatment, there are several fertility preservation strategies available. For women who have been through puberty, cryopreserving embryos or eggs for future fertility treatments may be the easiest and most reliable means of fertility preservation. Fertility-sparing surgery that spares the uterus or an ovary is sometimes an option. For girls who have not gone through puberty, there are ongoing studies into procedures that address infertility through freezing and re-implanting healthy ovarian tissue, called ovarian tissue cryopreservation.

 

Sources: American Cancer Society, American Society of Clinical Oncology, Centers for Disease Control and Prevention, and U.S. National Library of Medicine