Fertility

Cancer treatment may affect reproductive health in a variety of ways-

• Surgery of reproductive structures may result in erectile dysfunction or retrograde ejaculation, leading to the inability to release sperm naturally into the vagina.
• Radiation to the testes and some chemotherapy drugs can impair your ability to produce healthy sperm. You may recover from this after treatment; however, this may take months or even years. Predicting who will regain sperm production and who will not is difficult.
• Radiation or surgery to certain areas of the brain may reduce development of the pituitary gland hormones that stimulate sperm production.

For women and/or girls:

• Surgery may require removal of organs needed to become pregnant or maintain a pregnancy (for example, hysterectomy, removal of ovaries).
• Radiation to the pelvis and some chemotherapy drugs may destroy eggs in the ovary, making it more difficult or impossible to become pregnant. In addition, monthly menstrual periods may stop. Menstruation may start again after some months, but some women develop premature (early) menopause. These women stop ovulating and are not able to become pregnant. Again, predicting who will be affected is difficult.
• Radiation to the pelvis may cause changes in the uterus. As a result, an embryo may not be able to implant, or the uterus may not be able to expand to hold a growing fetus. This can result in complications during pregnancy such as miscarriage, preterm (early) birth, or low birth weight babies.
• Radiation or surgery to certain areas of the brain may reduce development of pituitary gland hormones that stimulate the ovaries each month, disrupting the monthly menstrual cycle and interfering with ovulation.

Men

Fertility preservation for men involves collecting and freezing semen before beginning cancer treatment. The sperm can later be thawed and used to fertilize eggs of a partner when they are ready to start a family.

For boys who have not reached puberty, said Dr. Jungheim, testicular tissue banking is available at a handful of centers, but experts do not know how successful this procedure is. It should be done under the guidance of an institutional review board if it is going to be done, she advised.

Women

Fertility preservation for women involves collecting eggs before beginning cancer treatment, a procedure performed by a reproductive endocrinologist. The standard approach is called embryo freezing (cryopreservation).

The first step is to stimulate the ovaries using medication so that multiple eggs will mature. When the eggs have matured, the woman undergoes egg retrieval during an office visit. The eggs are fertilized with sperm to create embryos (in vitro fertilization). The embryos are monitored for several days and then frozen and stored. Embryos can be stored for many years. The embryos can later be thawed and transferred into that woman’s uterus or into the uterus of another woman (or “gestational carrier”).