Cancer Treatment and Fertility in Women
How Cancer Treatment Can Affect Fertility
- Surgery—Removal of cancerous lesions in the areas of the cervix, ovaries, endometrium, and uterus may result in infertility. Factors such as the stage and spread of the cancer often dictate how extensive the surgery is, and, therefore, how much of an impact it may have on fertility.
- Radiation—In some cases, cancerous lesions on reproductive organs, such as the ovaries, are not surgically removed, but rather treated with radiation. In addition to killing the cancer cells, radiation may also damage healthy cells, thereby disrupting the function of the organs and possibly causing infertility.
- Chemotherapy—Unlike radiation, which is generally targeted directly to the area of the body with cancer, chemotherapy travels throughout the body in the bloodstream to kill cancer cells. As a result, it can also damage the reproductive system (even if the cancer is not present in the reproductive organs). Risk will vary based on several factors, including the type and dose of chemotherapy drug being administered.
Options for Preserving Fertility
- Ovarian transposition—This involves moving one or both ovaries away from the radiation field prior to treatment to minimize radiation exposure and damage to the ovaries. Sometimes the ovaries can be transposed behind the uterus or even onto the woman’s thighs.
- Radical trachelectomy—This procedure, used for patients with early stage cervical cancer, involves removal of the cervix while preserving the uterus. The problem here is that the cervix is the lowest portion of the uterus and removal of this portion of the uterus will likely result in the inability of the uterus to maintain the pregnancy.
- Freezing of embryos—This procedure involves the removal of eggs, which are then fertilized via in vitro fertilization and then frozen for future implantation.
- Freezing of unfertilized eggs—This procedure involves administering hormones to foster the development of follicles, after which unfertilized eggs are removed and frozen for future use.
- Freezing of ovarian tissue—This procedure involves removing an ovary and freezing small pieces of the ovarian tissue as a way to preserve eggs.
- Hormonal treatment—This involves taking hormones in the form of birth control pills or gonadotropin-releasing hormone along with chemotherapy, which may reduce the damage the chemotherapy does to the reproductive system.
- Radiation shielding—This involves shielding reproductive organs to reduce the radiation they receive.
Deciding What Is Best for You
Canadian Cancer Society http://www.cancer.ca/
Women's Health Matters http://www.womenshealthmatters.ca/
Female reproductive options. Fertile Hope website. Available at: http://www.fertilehope.org/healthcare-professionals/clinical-tools/female%5Foptions%5Fv3.pdf. Updated 2007. Accessed December 4, 2012.
Lee SJ, Schover LR, et al., ASCO Recommendations on Fertility Preservation in Cancer Patients: Guideline Summary. J Clin Oncol. 2006;24(18):2917-31.
Makar AP, Trope C. Fertility preservation in gynecologic cancer. Acta Obstet Gynaecol Scand. 2001;80:794-802.
Ovarian Cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 3, 2012. Accessed December 4, 2012.
- Reviewer: Brian Randall, MD
- Review Date: 12/2012 -
- Update Date: 12/04/2012 -