Cancer and its treatment may cause many changes in the body. Cancer treatment, especially chemotherapy drugs, affects fertility and you may be unable to get pregnant. However, there are ways to preserve the eggs to avoid any issues related to fertility after chemotherapy for women. Continue reading to know how chemotherapy affects fertility and how to ensure that you can get pregnant post the treatment.
The ability to conceive a child is called fertility. If you are a woman, fertility means you can get pregnant naturally and carry the child through the entire pregnancy term. Your fertility depends on various factors, including the healthy functioning of your reproductive organs and specific hormones. It also depends on whether your partner has fertility problems. If something changes in the body, for instance, the hormones function or how some organs work, it may become difficult to conceive a baby naturally or carry the child full term.
Healthcare providers may diagnose fertility issues in you or your partner when you are unable to conceive after 12 or more months of intercourse.
The relationship between chemotherapy and female fertility is quite complex. At birth, a newborn girl has the maximum number of fertile eggs she will ever have stored in the ovaries. As she grows and goes through puberty, the ovaries release eggs during the monthly menstrual cycle. This goes on till menopause when the hormone cycles stop. Changes or damage to this process can lead to fertility issues. Changes in the functioning of the ovaries, and the hormone production, which are essential to release mature eggs from the ovaries every month, also cause fertility issues. This can prevent conception or carrying the baby full term.
Chemotherapy is a cancer treatment that kills cells that divide quickly in the body. It may affect fertility and this happens because of
Damage to the reproductive organs (uterus, ovaries, cervix or fallopian tubes)
Damage to hormone production organs (pituitary glands or ovaries)
Damage to your ovaries leads to a reduction in healthy egg production, which leads to fertility problems. Once the mature eggs are lost, you cannot replace them.
Certain factors make it more or less likely to have fertility problems because of cancer treatment. Some of them are:
Good quality and quantity of eggs in your ovaries are present at a younger age. This means that even if there is some damage due to cancer treatments, there is a good chance of maintaining fertility. Women under 35 who have undergone cancer treatment have a good chance of natural conception after treatment. Depending on the type of treatment, some women in their early reproductive age do not stop getting periods. Young women whose monthly menstrual cycle stops during treatment might start again after they are off treatment for a while.
After having chemo, you are likely to have early menopause if:
You got cancer treatment, especially chemo, before puberty
You are a woman whose periods have returned after chemo
When your menstrual cycle stops before 40, it is called primary ovarian insufficiency or premature ovarian failure. Your ovaries are no longer making hormones that are essential for fertility. If you have had surgical removal of reproductive organs, you cannot get pregnant. Remember - having periods doesn't mean fertility is intact, even if you get back your periods, you may not be fertile. To know about your fertility stage and how long the fertility window may last, consult a gynaecologist. They may run some tests and be able to give you a detailed view on your fertility condition.
Chemotherapy kills cells that divide quickly in the body. This includes cancerous cells and good cells in ovaries (oocytes). The oocytes make the estrogen hormone that is needed to release eggs from ovaries every month and prepare the uterus for pregnancy. Loss of this and other reproductive hormones may affect fertility and also cause early or premature menopause, which can be permanent or temporary.
Chemotherapy medicines may also reduce the quality and quantity of eggs in the ovaries, making it difficult to get pregnant post the treatment. Whether you are fertile or not after chemotherapy depends on your stage in life and age. Other factors that affect fertility are the cancer type, the type of chemotherapy used, the dosage and hormone levels after treatment. Some medicines like Procarbazine, Melphalan, Lomustine, Busulfan, Carmustine, etc. may lead to fertility issues in women.
High chemotherapy doses are likely to lead to fertility changes. Additionally, if you have to take radiation along with chemotherapy medicines, the risk of fertility issues increases.
It is essential to know that women should not get pregnant during chemo as it may harm the baby. It can lead to miscarriage or congenital disabilities. Some women may become pregnant even after their monthly cycle has stopped, so it is essential to use proper birth control to prevent pregnancy during treatment. If you want to conceive after treatment, ensure you know the waiting period before trying.
There are ways to preserve your fertility before you start chemo treatment, and these are called chemotherapy-induced infertility treatments. Some possible options are:
Fertility medicines are used to stimulate egg production from the ovaries, which is called ovarian stimulation. Doctors then harvest your eggs using your partner’s sperm to create embryos through fertilisation in a lab. These embryos are then frozen in a lab until you are ready to have a baby. When you are fit, the embryo is implanted into the womb through IVF.
You can freeze your eggs until you are ready for pregnancy, which is similar to IVF. Drugs are given to stimulate the ovaries, and then the doctors collect the eggs and freeze them. When you are prepared, the sperm is injected to form an embryo and injected into your womb.
One of the best ways of chemotherapy and egg preservation options is ovarian tissue cryopreservation. It is a surgical method where one of the ovaries is removed and frozen. Once the cancer treatment is done, the tissue is placed back. The ovaries start working and produce eggs, maintaining your fertility.
A drug is injected so that the ovaries stop working and make the woman get into a menopause phase, which is called ovarian suppression. The drug may be injected a week before chemotherapy and it may protect the ovaries from the side effects of treatment, thereby preserving fertility. This treatment is not for everyone and success is not guaranteed.
Other Fertility Options
Using donor eggs
Using donated embryos
Surrogacy
Some chemotherapy medicines or treatments damage the ovarian follicles and eggs, which may cause permanent or temporary fertility issues. Depending on your desire to have a baby and your situation, you can find options to preserve fertility. Consult a specialist to know your options before starting cancer treatment.
