Fertility and Cancer Treatment

The ability to have children in the future is one of the many worrisome issues patients face when diagnosed with cancer.

The strictly regulated processes that lead to conditions of fertilization and healthy development of an egg in the uterus require precise balance. Chemotherapy, hormonal therapies, targeted therapies, or irradiation involving the reproductive organs may disrupt the balance of hormonal influences or lead to DNA damage during egg or sperm development. For both men and women, effects of chemotherapy on fertility depend on the specific therapy given, the dose, and the patient’s age.

Many patients treated for cancer can preserve their fertility, especially if they have the option of delaying treatment for 2 to 4 weeks (without significant effect on their outcome) to pursue fertility preservation efforts.

For those wishing to preserve options beyond adoption or surrogacy, treatment options for women with cancer include egg (oocyte) freezing, embryo freezing, and gonadotropin-releasing hormone (GnRH) treatment (ovarian suppression). Oocyte freezing, also known as oocyte cryopreservation, is an established method of preserving female fertility and an ideal approach for women without a current partner who want to preserve their fertility. Mature eggs are removed and frozen prior to fertilization with sperm. Such treatment takes 2 to 4 weeks to complete.

Embryo freezing, also known as embryo cryopreservation, is a more common and successful method of preserving fertility in women. It requires a sperm donor at the time that eggs are removed from a woman’s ovaries, and then in vitro fertilization (IVF). Embryos are then frozen until completion of treatment. This process also requires 2 to 4 weeks.

Since GnRH is a hormone that controls other hormones that regulate the menstrual cycle, continuous GnRH treatment during cancer therapy may protect the ovaries from damage by “tricking” the body to thinking it is pregnant, thus preventing ovulation and reducing the number of eggs harmed during treatment. This is still an experimental treatment.

Sperm banking is currently the most effective method of preserving fertility for men. The process takes from 2 to 4 hours. Men are advised to bank sperm prior to receiving chemotherapy or radiotherapy because these treatments reduce fertility. Sperm are then frozen to be used later to fertilize an egg via artificial insemination (directly injecting sperm into the uterus) or IVF.

Discussions of fertility preservation options should include the patient, their spouse or significant other, the treating oncologist, and potentially a fertility specialist. It is helpful to review all options as early as possible when developing a treatment plan, which should include referral to a sperm bank or egg/embryo preservation facility when appropriate. Fortunately, many patients who wish to have children after being treated for cancer are able to do so.

Published Online: January 28, 2016. doi:10.1001/jamaoncol.2015.4143.

Conflict of Interest Disclosures: None reported.