What are the effects of cancer on fertility?
Cancer has the potential to impact the fertility of men and women in direct and indirect ways. The types of cancers of the reproductive system that threaten a man's fertility range from testicular to penile cancer, while ovarian and uterine cancers are examples of reproductive system diseases that can make it difficult -- and in some cases, impossible -- for a woman to conceive.
When the endocrine system is targeted by cancer, a man or woman may become infertile. Even if the reproductive and hormone-producing centers of the body remain untouched, cancer can still impact the ability to have children. This is because stresses of any kind -- those associated with lung cancer, for example -- can signal the body to concentrate all its energies on fighting the disease rather than producing sperm or eggs [sources: FertilityProRegistry; Dawson].
In many cases, it's not the cancer itself that threatens fertility. It's the treatment required to eliminate the disease or slow its progress that's responsible for causing a temporary or permanent inability to reproduce. For many years, cancer patients weren't even told that chemotherapy, radiation or surgery would have an impact on their chances of having children. The physician's focus was solely on combating the immediate problem rather than considering the future effects of the life-saving efforts.
But advances have been made in the way doctors are advised to handle the issue. Since 2006, the American Society of Clinical Oncology has encouraged doctors to speak with patients about the threats to infertility posed by various cancer treatments and the options the patient has to preserve fertility, even if the prospect of having a child is years in the future [source: National Cancer Institute].
How Cancer Treatments Affect Fertility
The number of men and women in the United States alone that have cancer and are also old enough or young enough to have children is estimated at about 800,000 [source: American Society for Reproductive Medicine]. This puts both the doctor and patient in a difficult position. There's a strong desire to aggressively fight the disease and to do so promptly. But immediate action that doesn't take into account a patient's desire to eventually have children can be irreversible.
Advances in medicine have reduced the dangers posed by cancer treatments, but they still exist. The most prevalent threat to male infertility comes from radiation or chemotherapy. Both treatments can harm sperm [source: National Cancer Institute]. Naturally, the removal of one or both testicles or the prostate can reduce or eliminate the ability to reproduce.
Likewise, a hysterectomy or mastectomy directly impacts reproduction, while any treatment that influences the balance of a woman's hormones or harms her eggs can greatly reduce or erase her odds of having a successful pregnancy. Chemotherapy and radiation destroy cells that would otherwise continue to divide, regardless of whether those cells are healthy or not [sources: FertilityProRegistry; National Cancer Institute].
There are many options to preserve fertility -- some are common and others experimental -- but they have to be considered, and considered quickly, prior to undergoing cancer treatment. That's why the American Society of Clinical Oncology has created an outline of suggestions for doctors to follow while discussing the matter with patients [source: National Cancer Institute].
Oncofertility: Oncology and Assisted Reproduction
There's a small window of time available for a patient diagnosed with cancer to make decisions regarding reproduction and whether to attempt to preserve his or her fertility. Studies have indicated, however, that people who have explored their fertility options are more at peace as they move forward to put their primary focus on fighting the disease [source: National Cancer Institute].
The two most widely used and tested options for men and women wanting to have a family at some point following cancer treatment are freezing sperm or embryos and banking those sperm or embryos for use at a later date. Another option that is in the experimental stage involves taking a biopsy from a girl or boy in cancer treatment. In the case of a boy, a piece of testicular tissue is removed and frozen in the hope that stem cells from sperm can be grown in the future. Likewise, one ovary or a biopsy of an ovary can be taken from a girl, frozen, and potentially used for reimplanatation when she is cancer free and of child-bearing age [source: National Cancer Institute].
Cancer survivors are often concerned that the treatments they have undergone could result in birth defects in the children they ultimately choose to have. Initial studies, however, have indicated that while the children of cancer survivors are more prone to premature birth and low birth weight, they are no more likely to be born with defects than any other babies [source: National Cancer Institute].
Cryogenics: Sperm and Embryo Storage
It's difficult for a person to look down the road of life when the focus is on taking one step at a time. But it's possible to do both successfully, particularly with the help of an informed physician. Cancer can render a patient infertile but still capable of having a baby that is related to him or her genetically. Sperm and embryo storage is, at this point, the best and most popular option.
During this common process, a sample of a man's semen is taken prior to his undergoing cancer treatments. The sperm can be safely stored for years and then used for insemination, in vitro fertilization or intra-cytoplasmic injection. Women have a more problematic, though viable, option. If there is enough time available before cancer treatments begin, a woman can undergo in vitro fertilization.
Naturally, a woman who is not in a relationship with a man she wants to have children with is faced with the unavailability of sperm. If sperm is available and an embryo is successfully created, it can then be stored for a lengthy period of time and used in reimplanatation once the cancer has been treated. But, cryogenics for men and women are expensive. In the case of a woman, it can also stall the process of fighting the disease [source: American Society for Reproductive Medicine].
The rate of survival in youthful individuals with cancer is rising [source: The New England Journal of Medicine]. With that in mind, an increasing number of doctors and their patients are exploring options to preserve fertility and the promise of family life at a later date. Some of these options are now common while others are still under investigation. A thorough discussion of fertility and the threats to reproduction caused by cancer treatments is an important part of the doctor/patient relationship in such challenging situations.