Preservation of Fertility in Cancer Patients

April 6, 2009

One of my many interests in the field of women's cancers is the preservation of fertility in women undergoing treatment for cancer.

One of my many interests in the field of women's cancers is the preservation of fertility in women undergoing treatment for cancer. This is an important yet often overlooked aspect of cancer survivorship and the American Society of Clinical Oncology (ASCO) has published a position statement on this very issue (see below).

Being given a diagnosis of cancer is traumatizing, and trying to place a perspective on this life altering diagnosis for a young woman can be all the more difficult. Its effects on relationships, menstrual cycles, fertility, overall health, and emotional well-being can often take a back seat, especially when the first thoughts can be "I'm too young to die." But, placing a cancer-diagnosis into the context, not of a death sentence, but as a disease to be treated, is especially important, and provides some room to consider the other potentially life-altering effects that cancer and its treatments can induce.

As more women (and men) survive a cancer diagnosis, it has become more important for those of us to treat cancer to place an emphasis on considering cancer survivorship even before treatment begins. For the young woman, it means trying to gage where women are in their reproductive life, and provide the counselling and assistance for those wishing to preserve their fertility, and become parents in the future.

Fortunately, great work is being done in this arena of fertility preservation. We are learning more about the risks associated with different chemotherapies on ovarian function, the concept of ovarian reserves, and also have dedicated expertise in the area of reproductive endocrinology, as well as the fantastic organization fertileHope.

Recently, a paper was published by WO and Viswanathan from the Radiation Oncology Program at Harvard Medical School. In it, they evalauted the long-term effects of radiation therapy in women cancer survivors. They conducted a literature search and reported that radiation of the head or spine affected the hormonal milieu of women which impacted on their ability to achieve pregnancy years after they were radiated. Uterine problems were reported in women who were treated with radiation to the pelvis or abdomen, which was associated with higher risks of miscarriage or preterm labor. As expected, radiation affecting the ovaries (as is the case with cervical cancer treatment) lead to ovarian failure, resulting in early menopause.

The importance of this review is not so much what was reported (which for those of us who treat women with cancer would consider not necessarily new), but that the perspective placed on the long-term sequelae is an important consideration for physicians to bring their patients. Education is power and knowing the potential risks of radiotherapy can be an important motivator for the woman who wishes to preserve the option of carrying her own child in the future.

For those who are not able to have children due to cancer treatment, though, alternative modalities to parenthood are available. Aside from adoption (which can prove to be difficult for cancer survivors), surrogacy is a legitimate though expensive option. Again, fertileHope is a good place to start for any woman interested or concerned about this topic.

For more information:

1. ASCO Position Statement.

2. Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients.Int J Radiat Oncol Biol Phys. 2009;73:1304-12.

3. http://www.fertilehope.org.