Fertility issues
Fertility issues can arise for individuals who have undergone cancer treatments, as certain therapies such as chemotherapy and radiation may impair reproductive functions. Infertility can be temporary or permanent, depending on various factors, including the type of cancer and treatment received. For natural conception, men need healthy sperm production, while women require viable eggs and a functioning reproductive system. Cancer treatments can damage these critical reproductive components, leading to potential challenges in starting a family post-treatment.
To mitigate these risks, patients are encouraged to discuss fertility preservation options with healthcare professionals before beginning cancer therapy. Strategies may include sperm banking or egg freezing, although these methods can be costly and may influence treatment efficacy. For prepubescent children, preserving fertility is more complex, with ongoing research exploring the potential for restoring reproductive function after treatment.
Cancer survivors contemplating parenthood after treatment face additional considerations, including the timing of conception and concerns about the health of potential offspring. Despite worries about congenital disabilities or inherited cancer risks, studies indicate no significant increase in such issues among children born to cancer survivors. Various paths to parenthood, including assisted reproductive technologies, donor options, or adoption, offer hope for those unable to conceive naturally.
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Fertility issues
DEFINITION: Some cancers and cancer treatments pose a risk to a cancer survivor’s fertility. Infertility or sterility can be temporary or permanent. Although, in many cases, there are few options to address the underlying causes of infertility, many patients can preserve their fertility before undergoing cancer treatment and naturally conceive a child after treatment or through the use of assisted reproductive technologies.
Infertility and cancer: For natural conception, men must have at least one testicle that produces enough healthy sperm, the hormones to regulate sperm production, and the ability to make semen and ejaculate the semen. Women need at least one ovary that makes mature and viable eggs, a Fallopian tube through which the egg can be fertilized, a uterus capable of maintaining a pregnancy, and the hormones necessary for ovulation and pregnancy. Chemotherapy and radiation during cancer treatments can damage or kill cells required for producing sperm (sperm stem cells) and immature eggs (oocytes) or mature eggs. These treatments can also affect the production and regulation of hormones required for reproduction. Male and female reproductive structures can be damaged by radiation, removed, or damaged by surgery.
Fertility preservation: Infertility can cause a great deal of psychological distress for cancer survivors. It is advised that cancer patients discuss fertility issues with their oncologists and consult a fertility specialist before treatment. Specialists can inform patients of their risk, if known, of becoming infertile after treatment. In some cases, there are fertility preservation methods that can be undertaken before or during treatment. Patients must weigh the costs and benefits as some preservation methods may alter the efficacy of the cancer treatment, especially if the cancer is hormonally sensitive or affects the reproductive organs. Another possibility in some cases is delaying cancer treatments to pursue fertility preservation. Fertility preservation procedures, including long-term storage of sperm, can be expensive. Assisted reproductive technologies can assist in conception after treatment, but not all patients will want to pursue them or be able to pay for them.
Fertility preservation before puberty: Many parents are concerned about protecting a prepubescent child’s fertility from the effects of cancer treatment. Treatments can prevent, delay, or accelerate puberty. The effects on fertility may be permanent or may not be evident until later in life, when they can shorten a person’s reproductive years. Preserving fertility in a child can be a challenge. Fertility-sparing treatment methods that protect reproductive organs from radiation or conservative surgery on reproductive structures may prevent damage to a child’s reproductive systems. Because prepubescent boys and girls cannot make mature sperm or eggs, respectively, researchers are investigating whether testicular or ovarian function can be restored by transplanting back testicular or ovarian tissue that was collected and frozen before treatment.
Parenthood for cancer survivors: Cancer survivors confront many issues when considering parenthood after treatment. Oncologists typically advise waiting two to five years after treatment before trying to conceive naturally or through assisted reproduction technologies. Fertility may improve over time as damage to sperm or eggs is naturally repaired. Some cancer treatments also damage the heart and lungs, which can complicate a pregnancy. Therefore, women may benefit from waiting. Oncologists also recommend waiting to see if the cancer returns. The likelihood of reoccurrence affects a person’s decision to become a parent.
When considering parenthood, many survivors have concerns about the possible impact of cancer or cancer treatments on the health of a baby. Still, the literature does not indicate any increase in congenital disabilities in children born to cancer survivors. Some are also concerned about their children inheriting a cancer-causing gene or the genetic tendency to develop cancer. Genetic counselors can help estimate that risk.
Survivors who are unable to conceive a child who is genetically related to both parents still have options for parenthood. A sperm donor can be used to fertilize a partner’s egg. Similarly, donated eggs can be fertilized by a partner’s sperm. In these cases, the child would be genetically related to one parent. Women whose eggs cannot be fertilized may still be able to carry a pregnancy. These women can use donated embryos created through in vitro fertilization. Survivors may also consider adoption. Many adoption agencies require a letter from an oncologist that the prospective parent is cancer-free and is expected to have an average lifespan and a good quality of life. Some agencies require survivors to be cancer-free for a certain amount of time before being eligible for adoption.
Bibliography
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