Includes: Preservation of fertility and pregnancy warnings

Preservation of Fertility

What causes infertility?

• Infertility is often a major concern to men and women of childbearing age, who are undergoing treatment for their cancer.
• Common causes of infertility in patients with cancer include:
  • Chemotherapy - This is related to the type of drug, dose and length of treatment.
  • Radiation - due to pelvic radiation in males and females. This is also dependent on the dose of radiation that was received, and the age during therapy.
  • Cancer-related surgery - in women, with cancer of the endometrium, or ovaries, who may have had a hysterectomy- infertility may result depending on the size and type of tumor.  Men who have received a penectomy, orchiectomy, removal of the prostate gland, or seminal vesicles (which produce semen), may experience infertility
  • Age - also an important factor, more so for women than men. Women who are older are more likely to go into an early menopause (the stopping of monthly periods) from their treatment, than younger women.

How does infertility result?

• In men, infertility occurs primarily through damage to the lining of the testicles, which produce sperm.  Very small amounts of sperm may be produced (oligospermia), or there may be no detectable sperm in the semen (azoospermia). 
• It is possible for the damage to the lining of the testicles to reverse; however the process may take several years. In some cases, the damage may be permanent. 
• Drugs which may cause infertility in men and women include:
  • Alkylating agents- such as busulfan, cisplatin, cyclophosphamide, ifosfamide and melphalan.
  • Other categories of chemotherapy drugs, include Cytarabine, 5-flurouracil, methotrexate, vincristine, vinblastine, bleomycin, doxorubicin, and daunorubicin.

How do you preserve fertility?

• If possible, careful selection of the chemotherapeutic agents for men and women may help decrease incidence of infertility
• For women: infertility is affected by age.  Women in their 30's are capable of tolerating much higher doses of chemotherapy without experiencing menopause, either temporarily or permanently, than women in their 40's or older.
• Chemotherapy can cause ovarian damage or failure.  The ovaries are essential to a woman's ability to become pregnant. Women in their 40's are closer to menopause, and experience symptoms of menopause and infertility more frequently. 
• Women may become menopausal as a result of certain chemotherapy medications, and experience symptoms associated with menopause such as hot flashes, vaginal dryness, and painful intercourse.
• Hormones may help alleviate some of the menopausal symptoms, but may not be recommended for estrogen positive breast cancer patients, or those patients with hormone sensitive tumors.
• The chemotherapy agents most associated with these symptoms are the alkylating agents (listed above in the previous section) with emphasis on cyclophosphamide or combination treatments including alkylating agents.
• For women, the ability to retrieve eggs and storing the egg, can be done at some centers. Unfortunately, freezing unfertilized eggs has yet not been successful, and is not available at many centers.  However, freezing embryos (fertilized eggs) has resulted in pregnancy. 
• Major centers continue to research avenues to preserve female fertility.

For men:  Shielding of the gonads in men, during radiation therapy, may preserve delicate tissue.

• Sperm banking in men
• Many centers have access to therapeutic sperm banking. Sperm banking should also be completed prior to the start of cancer treatment. 
• Sperm Banks often recommend 3-6 donations over a two-week period.  Each donation should be 8 hrs apart, and 48 hrs after sexual activity to allow for the collection of the most sperm with each donation. 
• Donations are frozen and may be stored up to 50 years without damage.  A modest storage fee is involved for each year the sperm are stored. 
• Sperm may also be recovered from the urine for men who have retrograde ejaculation. 
• Discuss sperm banking as an alternative with your physician before you begin your treatment.

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Pregnancy In Cancer

What about pregnancy in cancer?

• For men and women of childbearing age, it is possible to conceive a child during cancer chemotherapy.
• Prevention of pregnancy is very important, due to the risk of birth defects, stillbirths, miscarriages, or spontaneous abortions as a result of treatment.
• Many individuals do not believe that birth control should be used because of religious or cultural beliefs, or feel that they will become infertile as a result of therapy, so this is their "last chance" for a baby. 
• Regardless, it is important that you do not become pregnant once you agree upon, and are undergoing chemotherapy treatment. Chemotherapy can damage the developing fetus.
• For both men and women: Two methods of contraception, such as condoms and spermicides, are suggested. The chance of developing birth defects following chemotherapy may last for AT LEAST 1 year after chemotherapy treatment. 
• A diaphragm device that is fit by an obstetrician/gynecologist, in addition to the use of condoms, may be acceptable. Discuss this with your healthcare provider.
• Intrauterine devices (IUD's), are usually not recommended if you are going to become neutropenic (low white blood cells) because of the risk of infection.
• Hormonal birth control - most birth control pills contain the hormones estrogen and progesterone. These may not be right for you, if you have a hormone sensitive tumor.
• You should discuss with your physician or healthcare provider when you can safely become pregnant, after your treatment is completed.
   
• Some young women are pregnant upon diagnosis. The first trimester of pregnancy is the most critical in terms of risks to the fetus and its' development. In these cases, it is important to discuss with your doctor or healthcare provider, if keeping the baby is in your (and the baby's) best interest. Interventions that your healthcare providers may take include:
  • Sheltering the fetus during radiation
  • Avoiding chemotherapy agents during certain months of pregnancy (such as avoiding methotrexate or alkylating agents during the first trimester.
  • Frequent monitoring of the baby's development by an experienced obstetrician
• It is essential that you weigh the risks and benefits, for yourself and your family, before receiving chemotherapy, especially during the first 3 months of pregnancy.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.