Fertility After Gynecologic Cancer Treatment

About 20% of people diagnosed with gynecologic cancer are younger than 40, meaning they are of childbearing age. A gynecologic cancer diagnosis can be distressing. And if you have not yet had children or want more children, you may be faced with cancer treatments that can affect your fertility – your ability to conceive or have a child. While not being able to have children in the future may add to an already stressful situation, there are options to protect your fertility before starting treatment. If you’ve already completed cancer treatment and cannot get pregnant, there are available alternatives also. Read on to learn more about fertility after gynecologic cancer.

If you’re a person with a female reproductive system, you’re born with all the eggs you’ll ever have, and they’re stored in your ovaries – this is called the ovarian reserve. Once the eggs in your ovarian reserve are lost, they cannot be replaced.

Infertility is the inability to have a child or to carry a baby through pregnancy. You may be diagnosed with infertility if the organs involved in reproduction or hormone production – the ovaries, fallopian tubes, uterus, and cervix – are damaged.

How does cancer treatment affect your fertility?

Treatment for gynecologic cancer may include surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy. Your treatment depends on the type of cancer, whether the tumor has spread, and your overall health.

Here’s how cancer treatment can cause fertility problems:

Surgery

Surgery that involves removing one or more of the reproductive organs may affect your ability to have children.

For example, during a hysterectomy, your uterus (the womb) is removed, preventing you from being able to carry a pregnancy.

If your cervix is removed in a procedure called trachelectomy, you may still be able to get pregnant, but you may be at increased risk of having a miscarriage.

An oophorectomy – the removal of your ovaries – means that your eggs are also removed, affecting your fertility. In some cases, your surgeon might remove only one ovary, which may still allow you to get pregnant.

Chemotherapy

Because chemotherapy drugs kill fast-growing cells that divide quickly, they can destroy cancer cells and normal cells.

In doing so, chemotherapy may affect your immature egg cells, called oocytes, which divide quickly. When your oocytes are affected, hormones such as estrogen – an important part of pregnancy – cannot be released. This can cause temporary or permanent infertility.

Certain chemotherapy drugs have a high risk of causing infertility, and some carry a low risk. If your doctor says you need chemotherapy and you desire to have children in the future, it’s essential that you bring up the question of fertility as soon as possible before starting treatment. That way, your oncologist may be able to offer you options to protect your fertility before treatment begins.

Radiation therapy

Radiation therapy kills cancer cells by using an external machine that aims high-energy x-rays at the tumor. This is called external beam radiation therapy.

Sometimes, surrounding body parts can absorb the radiation. As a result, radiation given to a person’s reproductive organs or the pelvis area can affect fertility.

For example, radiation given to a tumor near the ovaries may be absorbed by the ovaries and destroy some or all your eggs. Radiation can also cause scarring, so if you receive radiation to the uterus, you may be at an increased risk of miscarriage since a scarred uterus may not be able to stretch to accommodate a growing unborn baby.

Sometimes, radiation is given internally – called brachytherapy. Radioactive materials are placed inside the body or near the tumor. If brachytherapy is delivered to your female reproductive organs, your fertility may also be affected.

Targeted therapy and immunotherapy

Your healthcare provider may recommend targeted therapy or immunotherapy as part of your cancer treatment. Because these drugs are new, their effect on fertility is still unclear.

What are the types of fertility preservation techniques?

Some people can get pregnant naturally after cancer treatment. Based on the type of cancer and treatment used, your doctor may recommend that you wait months to years before trying to become pregnant after treatment. Because so many factors are involved in cancer treatment, it’s difficult to predict if your fertility will be affected.

If you’re facing cancer treatment and wish to start a family, the good news is that there are ways to preserve fertility before beginning treatment. Talk to your doctor before cancer surgery or starting treatment about your interest in protecting your fertility.

They may refer you to a fertility specialist who will discuss the different options with you. Many of these options include cryopreservation – another word for “freezing.”

Embryo Cryopreservation: For this option, you receive fertility drugs for about 10 to 14 days. Then your eggs are collected and fertilized with sperm via in vitro fertilization (IVF). The formed embryos are then frozen for future use.

Unfertilized Eggs Cryopreservation: This option involves freezing your eggs without fertilizing them first. You would still take fertility drugs before. You may choose this option if you don’t have a partner or don’t want to use donated sperm.

Ovarian Cryopreservation: This procedure is still being researched and is considered investigational. Your ovarian tissue is removed and frozen. After cancer treatment, it is transplanted back. This is an option for young girls or people with certain types of cancer who cannot wait 10 to 14 days before starting cancer treatment.

Other options

Another method includes performing surgery in a way that protects your fertility. This is called fertility-sparing surgery.

If you need radiation therapy that might affect your ovaries, your surgeon may perform an ovarian transposition where your ovaries are moved out of the way of the radiation beams. This option is not always successful.

Ovarian suppression is an alternative that is still being researched. For this method, you receive hormone injections to decrease the activity in your ovaries during cancer treatment. Experts believe that ovarian suppression helps reduce chemotherapy’s harmful effect on your eggs.

Fertility preservation options carry risks, and the success rates differ based on the method and several factors. If you’re considering protecting your fertility before cancer treatment, have a thorough discussion with your doctor or fertility specialist about the pros and cons of the different methods, risks, effectiveness, cost, and your preferences.

How do I pay for fertility preservation?

In the U.S., health insurance coverage for fertility preservation may be limited. This means that, based on your health insurance plan, you may have to pay the full cost of the fertility preservation treatment.

These treatments can cost $10,000 to $15,000 plus a yearly storage fee of approximately $500, depending on the right option for you.

It’s a good idea to call your health insurance carrier to verify if you have coverage for fertility preservation and what your financial responsibility may be. If you need help paying for fertility preservation, certain companies offer financial assistance to cover some of the costs.

What options are available for people who are infertile after cancer treatment?

If you’ve already completed your cancer treatment and are cleared by your doctor to become pregnant but have trouble conceiving, the options below may help make having a baby possible:

  • You may use donor eggs. These eggs come from another person and are fertilized with your partner’s sperm via IVF. The resulting embryos are then transferred to your uterus to try and achieve a pregnancy. For this method, a healthy uterus is needed.
  • Donor embryo is another option similar to donor eggs, except that the egg has already been fertilized with someone else’s sperm. In this instance, your child will not have a genetic relationship with you or your partner.
  • You may also consider surrogacy, where another person carries the baby through pregnancy. This is an option if you no longer have a uterus or cannot carry a pregnancy.
  • Adoption and living child-free are additional alternatives if you have trouble having a baby after cancer treatment.

Conclusion

Fertility after gynecologic cancer treatment may be possible, but it requires planning. If you risk losing your fertility and wish to start a family after cancer treatment, an important step is to talk to your healthcare provider before your treatment. Various fertility preservation techniques are available to save your healthy eggs. Alternatively, if you’ve already completed treatment and struggle with fertility, some options may make having a baby possible.

Key takeaways

Finding out you have gynecologic cancer and discovering that your fertility may be affected can take an emotional toll. But know that you’re not alone!

Fertilization preservation uses techniques based on many factors and your preference to help make having a baby after cancer treatment possible.

An essential first step is to discuss your desire to protect your fertility with your healthcare provider before surgery or beginning treatment. Don’t expect your providers to bring it up. Be proactive and ask about it early!

Using donor eggs, donor embryos, surrogacy, adoption, and living child-free are available alternatives.

Resources:

Alliance for Fertility Preservation. Financial Assistance Programs.

Alliance for Fertility Preservation. Paying for Treatments.

American Cancer Society. How Cancer and Cancer Treatment Can Affect Fertility in Females.

American Cancer Society. Preserving Fertility in Females with Cancer.

American Society of Clinical Oncology. Fertility Concerns and Preservation for Women.

American Society of Clinical Oncology. Having a Baby After Cancer: Fertility Assistance and Other Options.

American Society for Reproductive Medicine. Infertility.

John Hopkins Medicine. Fertility and Cancer: What Are Your Options?

National Cancer Institute. Fertility Issues in Girls and Women With Cancer.

Nitecki, R., et al. (2020). Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies. Obstetrics and Gynecology.

Smith, K. L., et al. (2018). Advances in Fertility Preservation for Young Women With Cancer.

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