Cancer treatments can disrupt hormone levels or damage reproductive organs. Sperm banking and egg freezing offer hope for future biological parenthood.

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While advancements in cancer treatments have significantly increased survival rates, more people are now dealing with the side effects of these therapies, including the risk of infertility.

Let’s explore the various types of cancer treatments, their effects on female and male fertility, and the options available for preserving fertility.

Some cancer treatments, such as chemotherapy, radiation therapy, and certain surgeries, can affect fertility by damaging reproductive organs or interfering with hormone levels.

About 15% to 30% of males experience infertility after cancer treatment. And large studies suggest that women may be 35% to 38% less likely to conceive after cancer treatment than the larger population.

Here are some of the potential issues:

  • Treatment effects: Certain cancer treatments, including chemotherapy and radiation, can change hormone levels, induce early menopause in females, damage nerves, or impair the function of reproductive organs, leading to fertility problems.
  • Organ removal: Cancer surgery sometimes involves removing organs that are necessary for reproduction. For example, removing part or all of the testicles, penis, ovaries, uterus, or cervix can cause infertility.
  • Tumor damage: A tumor can directly damage reproductive organs or the surrounding tissues, affecting their function.
  • Psychological impact: The stress and anxiety associated with cancer diagnosis and treatment may also affect your fertility. Emotional distress can interfere with the desire or ability to have children.

How it affects female fertility

Chemotherapy, a common cancer treatment, can harm your ovaries and disrupt hormone levels, potentially leading to infertility and premature ovarian failure.

The effects can vary depending on the specific drugs used. A 2023 research review suggests that alkylating agents and topoisomerase inhibitors can significantly damage the ovaries, reducing the number of ovarian follicles and causing infertility.

Antimetabolites such as methotrexate may also affect developing follicles, leading to temporary infertility. Taxanes may harm fertility by reducing levels of anti-Müllerian hormone, which indicates the size of the ovarian reserve.

How it affects male fertility

Chemotherapy can affect male fertility by affecting spermatogonia, which are cells that develop into sperm. Because these cells are sensitive to chemotherapy drugs, chemotherapy treatment can lead to a decrease in sperm production over time.

At first, there may be fewer spermatocytes (the next stage of sperm development), and this will lead to a gradual loss of sperm production over several weeks. Ultimately, this process can result in a lower sperm count and, in some cases, no sperm at all in your semen.

Chemotherapy can also affect the quality of sperm, leading to DNA damage and potentially affecting the health of offspring. Hormonal changes caused by chemotherapy can also affect sperm production.

How it affects female fertility

Radiation therapy is often a crucial part of cancer treatment and is sometimes the first treatment recommended. However, ionizing radiation can have long lasting effects on fertility, including issues such as ovarian insufficiency, puberty delays, and infertility. Your cervix may also be affected, particularly if you have cervical cancer.

Radiation can deplete ovarian follicles, leading to premature ovarian failure and early menopause. Radiation therapy can also change the size, blood supply, and structure of your uterus, potentially causing difficulties in conceiving and increasing the risk of preterm birth or low birth weight.

In addition, radiation to your head can disrupt hormone production, affecting your menstrual cycle. It can also harm your uterus, leading to changes in its blood supply, size, and structure, which can affect fertility.

How it affects male fertility

Radiation therapy can affect male fertility by damaging your testicles, where sperm is produced. This damage can result in a temporary or permanent decrease in sperm production.

The extent of the damage depends on factors such as the dose of radiation, the area being treated, and your age. High doses of radiation to your testicles can lead to permanent infertility, while lower doses may cause a temporary decrease in sperm production that can recover over time.

How it affects female fertility

Hormone therapy, also known as endocrine therapy, is used to treat certain hormone-sensitive cancers, such as breast cancer. It works either by blocking your body’s natural hormones or by changing how they work, which stops cancer cells from growing.

However, this treatment can affect your menstrual cycle, causing irregular periods or even stopping periods altogether. These changes can reduce your chances of getting pregnant.

How it affects male fertility

Prostate cancer is often influenced or fueled by testosterone. Hormone therapy for prostate cancer aims to reduce testosterone levels or block the effects of testosterone, which can help slow down or stop the growth of cancer cells in your prostate gland.

However, reducing testosterone levels can also affect sperm production in your testes, leading to a decrease in sperm count and potential infertility. Additionally, hormone therapy can cause side effects such as erectile dysfunction, which can affect fertility.

How it affects female fertility

In females, the impact varies depending on the type of surgery and its effect on reproductive organs.

Removal of organs such as your ovaries, uterus, or fallopian tubes can directly affect fertility by eliminating or impairing their function. Your cervix may also be affected.

Surgeries that cause scarring or damage to reproductive organs or surrounding tissues can affect fertility as well.

How it affects male fertility

In males, cancer surgeries can harm fertility in various ways. For example, direct removal of structures such as your testes can affect sperm production and testosterone levels. Surgery can also create scar tissue that blocks sperm flow or affects organ function.

In addition, surgery can damage nerves, affecting ejaculation, or disrupt blood supply to reproductive organs.

Stem cell transplantation (SCT) is a critical treatment for various serious health conditions, both cancerous and noncancerous. It involves replacing damaged or diseased bone marrow with healthy stem cells to help your body produce normal blood cells. This procedure is particularly crucial for conditions such as leukemia, where it can be lifesaving.

However, SCT can have significant effects on fertility. The process often includes chemotherapy and, in some cases, radiation therapy. In women, this treatment can damage the ovaries, leading to disruptions in the menstrual cycle and potentially causing infertility. In men, SCT can harm the testes, affecting sperm production and fertility.

Fertility preservation is often necessary when cancer treatments, such as chemotherapy, surgery, or radiotherapy, threaten future fertility.

For females

Here are some ways to preserve female fertility before cancer treatment:

  • Freezing embryos or eggs: This procedure involves stimulating your ovaries to produce multiple eggs, which are then retrieved, fertilized with sperm, and frozen for future use. This is a well-established method for preserving fertility.
  • Using in vitro maturation (IVM) and freezing ovarian tissue: Immature eggs are collected from your ovaries, matured in a lab, and frozen. Ovarian tissue can also be removed and frozen for later use.
  • Undergoing fertility-preserving surgery: Procedures such as vaginal or abdominal radical trachelectomy, in which your cervix and upper vagina are removed, are now options.
  • Reimplanting frozen ovarian tissue: Frozen ovarian tissue can be reimplanted after cancer treatment to potentially restore hormone function and fertility.
  • Using protective agents for ovarian tissue preservation: Medications or techniques can protect your ovaries from cancer treatment’s damaging effects, preserving fertility.
  • Maturing early follicles outside your body: Immature follicles containing eggs are grown in a lab to a more mature stage for fertility treatment.
  • Using stem cells for fertility support: Stem cells from your ovaries or other sources may repair damaged ovarian tissue and restore fertility. This is an area of active research.

For males

The primary way of preserving male fertility is through sperm cryopreservation. This process involves collecting a semen sample containing sperm and freezing it at very low temperatures. The freezing stops all biological activity, effectively preserving the sperm for future use.

When you’re ready to start a family, the frozen sperm can be thawed and used in assisted reproductive techniques such as in vitro fertilization (IVF) or intrauterine insemination (IUI) to lead to pregnancy.

During radiation therapy, lead shields or cups can be used to protect your testicles from radiation while allowing the targeted area to receive treatment.

Coping with potential infertility from cancer treatment can be tough. Here are some tips:

  • Explore fertility preservation options: Before cancer treatment, talk with your healthcare team about fertility preservation options such as sperm or egg freezing.
  • Consider counseling: Counseling or a support group may help you cope with the emotional impact of infertility.
  • Stay informed: Stay informed about advancements in fertility treatments and options that may become available.
  • Seek professional help: Consider seeking help from a fertility specialist who can provide guidance and support tailored to your situation.
  • Consider adoption or surrogacy: If your fertility options are limited, you may want to explore adoption or surrogacy as an alternative path to parenthood.
  • Stay hopeful: Remember, infertility after cancer treatment can sometimes be temporary. Many people who have had cancer go on to have children. Try to keep a positive outlook and focus on the possibilities.

Prepubescent children can preserve fertility during cancer treatment through experimental methods such as freezing and storing ovarian or testicular tissue.

However, this raises ethical dilemmas due to the experimental nature of the procedures and the uncertainty of their effectiveness. There are concerns about the long-term impact on the child’s health, the ability of children and parents to make informed decisions, and the potential psychological effects on the child. 

Yes, some cancer treatments can cause temporary infertility. The duration varies depending on the type of treatment and your individual response.

For example, chemotherapy can temporarily suppress sperm production in men and ovarian function in women, but fertility may return within months to several years after treatment is complete.

In general, sperm banking for men and egg freezing for women are the most affordable options.

Sperm banking usually costs a few hundred dollars for initial collection and storage, while egg freezing can be more expensive, often costing several thousand dollars. Financial assistance programs and payment plans may be available to help cover these costs.

Many cancer treatments can affect fertility, so it’s important to consider fertility preservation methods before treatment. Options such as sperm banking and egg freezing may offer you the possibility of having biological children in the future.

Modern fertility preservation techniques allow you to look forward to life after treatment with the potential to start or grow your family if you choose.