Sadly, certain cancers and their treatments affect fertility in men and women, but thankfully there are methods of fertility preservation that can save or protect eggs, sperm and reproductive tissue, so cancer patients still have a chance to have their own biological children in the future.

It is a tragedy that 10 million people are lost each year to cancer, when more than 40% of cancers are preventable through lifestyle modifications, and at least one third of all deaths related to cancer could be prevented through routine screening, early detection and treatment.

This is the message of World Cancer Day, which aims to save millions of lives each year through education, raising awareness and encouraging action from governments and individuals around the globe.

On this year’s World Cancer Day, our team at Cape Fertility add our voices to raise awareness of the impact of cancer and its treatments on men’s and women’s fertility and what steps cancer patients can take to preserve their fertility before their cancer treatments commence, as detailed by the American Cancer Society.

The impact of cancer treatments on fertility

In people who were fertile before receiving cancer treatments and among those who receive certain types of cancer treatments, the body may not be changed by treatment or may recover after treatment, and fertility may not be impacted. Whether this happens depends on the patient’s age, stage in life, type of cancer, type and dose of treatment, and other health problems that may exist. However, in many cases, cancer treatments can result in people losing their fertility during cancer treatment, either temporarily or permanently.

For example, in women, certain types of cancer surgery can result in removal of organs needed for a pregnancy, and certain treatments might change hormone levels or cause damage to their eggs. Women who have had chemo or radiation to the pelvis are also at risk for sudden, early menopause even after they start having menstrual cycles again.

In men, cancer surgery can remove organs needed for reproduction, and certain treatments might change hormone levels or cause DNA damage to sperm. This can result in sperm that is unable to fertilise an egg, or result in miscarriages, or cause serious birth defects.

Fertility preservation options

Fortunately, there are steps cancer patients can take that might help preserve their fertility. Fertility preservation saves or protects embryos, eggs, sperm or reproductive tissue so that these can be used later to conceive their own biological children after the cancer treatment.

Steps to preserve fertility must be taken before cancer surgery or before cancer treatments begin, and the assistance of an accredited and registered reproductive specialist is essential.

The most common fertility preservation options are briefly detailed below thanks to the American Cancer Society.

Freezing embryos or eggs or sperm

Embryo freezing, or embryo cryopreservation, is an effective way to help preserve fertility. During this procedure, mature eggs from the female partner are collected and fertilised with sperm using in vitro fertilisation (IVF). The resulting embryo is then frozen. Later, after cancer treatment ends and the woman is ready to try to get pregnant, the embryo is thawed and put back into her uterus where it will hopefully become a pregnancy.

Similarly, egg freezing (or egg cryopreservation) is also an effective way to help preserve fertility. For egg freezing, mature eggs are removed from the female partner and frozen before being fertilised with sperm. When the woman is ready to try to become pregnant, the eggs can then be thawed, fertilised by a partner’s or donor’s sperm, and implanted in her uterus where it will hopefully become a pregnancy.

Ovarian tissue freezing involves all or part of one ovary being removed by laparoscopy (minimally invasive surgery), cut into small strips, frozen, and stored. After cancer treatment, the ovarian tissue can be thawed and transplanted in the pelvis, where it may start to function again.

Male cancer patients can also store their sperm for future use. The process involves providing one or more samples of semen, which are then frozen and stored. Once sperm is stored, it’s usually good for decades. When the couple is ready to try getting pregnant, the frozen sperm can be used to fertilise the female partner’s egg and return it to her uterus using procedures such as Intrauterine insemination (IUI), in vitro fertilisation (IVF) or in vitro fertilisation with intracytoplasmic sperm injection (IVF-ICSI). In general, sperm collected before cancer treatment is just as likely to start a pregnancy as sperm from men without cancer.

If you have frozen eggs, embryos, ovarian tissue or sperm, it’s important to stay in contact with the cryopreservation facility to be sure annual storage fees are paid and that your address is updated.

Ovarian transposition and suppression

A standard fertility preservation option for girls or young females who are going to get pelvic radiation is ovarian transposition, which means moving the ovaries away from the target zone of radiation treatment. Because of radiation scatter, this technique is not always successful.

Ovarian suppression involves the use of gonadotropin-releasing hormone (GnRH) agonists – long-acting hormone drugs – that make a woman go into menopause for a short time. The aim is to shut down the ovaries during cancer treatment to help protect them from damaging effects.

Radiation shielding

In men, radiation treatment can cause infertility through the permanent destruction of the sperm stem cells in the testicle. Testicular tissue damage is unavoidable if both testicles need to be directly radiated, but even when the radiation is directed at other structures in the pelvic area, the x-rays can often scatter and cause indirect testicular injury. Fertility may sometimes be preserved in these males by covering the testicles with a lead shield, called gonadal shielding or gonadal preservation.

Fertility-sparing surgery

In women with early-stage cervical cancer, it may be possible to remove the cervix without removing the entire uterus or ovaries. For early-stage ovarian cancer that only affects one ovary, the surgeon might be able to remove the one ovary that’s affected and not the other. Both of these procedures can help preserve fertility.

Similarly, progesterone therapy may be used for early-stage uterine cancer in younger women instead of the usual treatment, which would be surgery to remove the uterus, commonly known as a hysterectomy. Women with stage 1, Grade 1 endometrial cancer who still want to have a child might have the option to be treated instead with the hormone progesterone, via an intrauterine device (IUD) or as a pill.

Which fertility preservation option is right for you?

Preserving your fertility before undergoing cancer treatment will substantially improve your chances of still having your own biological children after cancer treatment, but it is crucial that you speak to a fertility specialist as soon as possible and before cancer treatment begins.

Your first step to preserving your fertility when facing cancer treatments is simply to contact us by clicking here…

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.