Treatment for cancer can cause infertility? Is it possible to prevent infertility?
Cancer treatment can make it difficult or even impossible for both women and men to have children.
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Permanent Infertility
The cause of permanent infertility is surgery due to a malignant tumor, which results in permanent loss of the reproductive system (e.g. hysterectomy with ovaries due to endometrial cancer or bilateral removal of the testicles due to bilateral testicular cancer). Men who require bilateral removal of the testicles (an operation called an orchiectomy) can deposit the semen in a sperm bank for use in a timely manner for artificial insemination (i.e., the introduction of the sperm into the uterine cavity) or other assisted reproductive techniques. In the case of women, there are technical options to freeze the eggs (fertilized and unfertilized) and to carry out the procedure of artificial fertilization entirely outside her body ( in vitro, i.e. under laboratory conditions). If the eggs or sperm have been frozen before treatment is started, assisted reproduction may be started at an appropriate time after the end of treatment for the tumor. If you need to undergo an operation that will make it impossible to have children in the future, it is worth asking for a consultation with an infertility specialist in Coimbatore in advance.
Sometimes cancer treatment requires the hormonal activity of the reproductive system to be turned off – a good example is the ovarian function blockage used in some breast cancer patients. In most cases, breast cancer is a malignant tumor that is affected by hormones (estrogens) that make it grow. Therefore, it is sometimes desirable to eliminate the action of hormones in order to slow down or stop the development of the disease. One method has already been mentioned – it involves the surgical removal of both ovaries (“surgical castration”) to significantly reduce estrogen levels. The ovaries can also be destroyed without resorting to surgery – radiotherapy is used for this purpose (an appropriate high dose of radiation will permanently destroy the ovary – “radiological castration”). However, both of these methods lead to irreversible damage to ovarian function and permanent infertility. After such procedures, there is no way to restore natural fertility, but there are methods of assisted reproduction.
Reversible infertility
Currently, the hormonal activity of the ovary can be temporarily blocked with the use of appropriate drugs, the so-called gonadoliberin analogues. These are drugs that for a certain period of time (1-6 months, depending on the form used) block the release of hormones that regulate the menstrual cycle; getting pregnant while using them is almost impossible. After they stop working, the natural menstrual cycle returns, and it becomes possible to become pregnant again.
However, it should be remembered that cancer treatment itself may cause infertility as a result of unintended side effects. Radiotherapy to the pelvic organs may cause unintentional ‘radiological castration’. Also, systemic treatment with the use of cytostatics (commonly, though not completely precisely referred to as chemotherapy) may lead to a reduction in fertility. The degree of fertility reduction depends primarily on the drugs used and their doses. In some simplification, it can be said that the use of certain drugs (e.g. cyclophosphamide, busulfan, melphalan, chlorambucil, dacarbazine, procarbazine, ifosfamide), thiotepa, mechlorethamine) is associated with the permanent cessation of menstruation in at least 80% of the women who were menstruating at the start of treatment. On the other hand, when using other drugs (e.g. methotrexate, bleomycin, fluorouracil, actinomycin D, mercaptopurine, vincristine)) the risk of permanent cessation of menses after treatment is less than 20%. In the case of other cytostatics, the risk of permanent cessation of menses is within a wide range of 20–80% and depends mainly on age (the younger the woman, the greater the likelihood of recovery of ovarian hormonal function) and the doses of drugs used. According to experts, cytostatics cause “maturation inhibition and a reduction in the number of primary follicles in the ovaries and sperm cells in the testes”.
Overall, given that the majority of women undergoing chemotherapy are in the perimenopausal period, approximately one in three patients undergoing treatment will return to menstruation after chemotherapy; at this point, it should be emphasized again that in younger women this percentage is much higher.
Sexual activity
Experts emphasize that undergoing chemotherapy does not affect the ability to maintain sexual activity and enjoy intercourse. However, radiation therapy and surgery, as methods that result in the physical destruction of tissue, can adversely affect both of these aspects. For example, radiation therapy used to treat prostate cancer may result in the inability to get an erection (erection). Prostatectomy (i.e. prostatectomy) may have the same effect. In turn, the consequence of rectal excision in men (especially in the case of tumors located close to the anus) may be the inability to obtain an erection (erection) and ejaculation disorders (ejaculation), and in women – dyspareunia (pain during sexual intercourse) and vaginal dryness. These complications occur with different frequencies and not in all patients, but they are clinically significant, as they significantly affect the deterioration of the patients’ quality of life after treatment. The modern technique of radiotherapy and the use of appropriate shields, as well as the continuous improvement of the precision of the surgeons’ work (including the introduction of procedures with the use of laparoscopy and surgical robots), mean that the risk of complications is systematically reduced, but still remains an important element of the radical treatment of certain cancers.
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Safety during pregnancy and the health of the baby
After undergoing anti-cancer treatment, as long as it did not involve castration, many women can become naturally pregnant and give birth to a healthy baby, and a man can father a healthy baby. However, experts recommend that you avoid conceiving children for at least 12 months after stopping treatment for cancer by using an appropriate method of contraception. In the case of patients with breast cancer, due to the strong dependence of this cancer on the hormonal status of a woman, pregnancy planning should be postponed for 2-3 years after the end of treatment (most cancer recurrences are observed within 2 years after the end of treatment).
There is no reliable data to suggest a higher risk of birth defects in babies born to women who have previously received cancer treatment. Also, children of such women were not noticed that they developed abnormally. There was also no greater risk of developing cancer than their peers.
When deciding to have a child after cancer treatment, a woman should see her best oncologist in Coimbatore for all tests to confirm that cancer has not come back, and then discuss the matter in detail with the gynecologist. There is no data that would undoubtedly indicate that pregnancy after anti-cancer treatment, especially after 2–3 years, worsens the overall prognosis.
The volume of milk produced in only one breast (in a woman whose other breast was amputated because of cancer) is usually sufficient to provide the baby with the necessary nutrients. After receiving chemotherapy in the past, you can breastfeed your baby without any restrictions. Radiotherapy, which has covered the upper half of the chest, is also not a contraindication to breastfeeding, but you must not breastfeed while receiving chemotherapy. According to experts, chemotherapy and/or radiotherapy do not change the composition of milk. It should also be emphasized that during lactation it is safe to perform breast ultrasound, and after emptying the breast milk, also mammography.