The sad truth about cancer is that it always presents life-altering repercussions to a patient and his family.
Although most cancers have a positive prognosis as a result of early detection, the treatment and the cancer itself can affect many organs of the body. The reproductive system, for one, is affected through radiation and chemotherapy, potentially causing infertility in patients, both men and women.
This, to a young couple who plan on having a family one day, could be utterly devastating. With the advances in medicine, however, cancer patients now have several options when trying to preserve fertility.
Cancer, to a couple who want to start a family, can be devastating.
Dr. Kelly Loi, an obstetrician and gynaecologist speaks about fertility conservation for cancer patients. She is a Ministry of Health-accredited fertility specialist from Mount Elizabeth Fertility Centre.
The following are her answers to common questions about fertility conservation for cancer patients, edited for clarity and brevity.
What is the risk of infertility after cancer treatment?
Cancer can impair fertility depending on the type of cancer in question and the treatment needed. Some patients may require surgery to remove their reproductive organs. Other patients may need chemotherapy or radiotherapy, which can reduce reproductive function.
With fertility conservation, cancer patients now have hope.
Chemotherapy, radiotherapy as well as bone marrow transplant can cure up to more than 90% of girls and young women with certain cancers. However, these treatments can also result in premature ovarian failure or early menopause, depending on the age of the patient and the type and dose of drugs used.
The risks to fertility from cancer may be classified as low, medium or high depending on the specific treatment required. High risk treatments with high chances of impairing fertility would include whole-body irradiation, or chemotherapy conditioning for bone-marrow transplant.
Is it safe to have a baby after cancer treatment? Read on the next page…
Is it safe to have a baby after cancer treatment?
It is important to discuss each case with the oncologist to determine if a pregnancy after cancer treatment would be safe. The timing of when to try to have a baby should also be discussed.
In theory, pregnancy may increase the risk of cancer recurrence in patients with certain hormone-sensitive tumours. This is because pregnancy is associated with high levels of hormones produced from the placenta.
For example, breast cancer is hormone-sensitive and it is usually advised that patients postpone their pregnancy until two to three years from the time of diagnosis to reduce the risk of recurrence.
Cancer treatment can damage the ovaries and other organs.
There are also possible effects of previous cancer treatment on pregnancy. With chemotherapy, for example, damage to eggs or sperm following cancer treatment may result in birth defects.
Radiotherapy, on the other hand, may affect the womb and increase the risk of low birth weight babies and preterm labour. Once again, multidisciplinary management is important with close collaboration between cancer doctors.
A patient planning to get pregnant should undergo preconception health assessment to determine if she is fit for pregnancy. This includes assessment of her heart, lung and kidney functions.
Someone who has undergone cancer treatment will have to have a thorough assessment to see if she is fit for pregnancy.
Blood tests may be required too. During pregnancy, she should have an early dating scan and be offered prenatal genetic screening at 11 to 14 weeks gestation. She should also have a detailed fetal anomaly scan at 20 weeks.
Serial growth scans are advisable throughout pregnancy. For delivery, Caesarean section may be needed. Once baby is born, modern neonatal healthcare facilities should be available to ensure the best outcome for the baby.
Learn about other options for preserving fertility before cancer treatment on the next page.
What are the other options for preserving fertility before cancer treatment?
Conservative surgery
Fertility conservation surgery might be possible in the early stages of the cancer.
Fertility preserving cancer treatment, including conservative surgery, may be possible in early stage cancer of the cervix or ovary. For early stage endometrial cancer, hormonal therapy may be considered to induce regression of cancer.
Freezing of embryos
Freezing of embryos may be performed if the patient is married. These embryos are obtained through ART or IVF. Hormonal injections are required followed by egg or oocyte retrieval.
The eggs are then fertilized with sperm to form embryos which are then frozen. Frozen embryos may then be thawed for future use.
Freezing of eggs or ovarian tissue
Freezing of eggs or ovarian tissue is considered to be a more experimental method. However, successful use of frozen eggs and ovarian tissue have been recorded.
Freezing embryos is another method of fertility conservation.
Eggs may now be frozen with minimal damage using a technique of rapid freezing called vitrification. Vitrified eggs have been thawed for fertilization to form embryos resulting in healthy pregnancies.
Ovarian tissue may be obtained by laparoscopic or minimally invasive surgery. The tissue may then be frozen and later thawed and transplanted back into the patient. This has been performed successfully, resulting in several live births.
What are the options for men before, during and after cancer treatment? Read on the next page.
What are the options for men before, during and after cancer treatment?
For men, sperm or testicular tissue should be stored before any cancer treatment. For adult males, semen cryopreservation is an established technique, but this is difficult in adolescents.
For adolescents as well as pre-pubertal boys, testicular tissue may be harvested before gonadotoxic cancer therapy and cryopreserved. While it is still largely experimental, testicular tissue banking is a promising method for fertility preservation in pre-pubertal boys undergoing oncological treatment.
Adult men with cancer have fertility conservation options as well.
What questions should patients be asking their doctor?
With the recent success and advances made in fertility preservation for cancer patients, international guidelines now recommend that these options should be discussed with the patient. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during the treatment planning process.
It is important to talk to your doctor about your options.
When cancer is diagnosed, patients should discuss with their doctor the cancer treatment recommended for them and the likely impact of the treatment on their quality of life, including their future fertility.
If fertility is desired, then an early referral to a fertility specialist would be ideal to allow for fertility preservation options to be discussed and conducted as expeditiously as possible with minimal delay to cancer treatment.
For more information about Mount Elizabeth Fertility Centre, click here or visit the Mount Elizabeth Hospital Facebook page.
We hope this article gave you an insight into the subject of fertility conservation for cancer patients. Please do share your thoughts on the subject with us by leaving a comment below.
