19 February 2024

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Fertility and Cancer: Preserving Hope for Parenthood

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Cancer presents not only physical challenges but also significant hurdles to fertility for both men and women. We learn more from Dr Roland Chieng, Medical Director of Virtus Fertility Centre.

Does cancer affect fertility?

Depending on the cancer type and location, it can directly impair reproductive functions and fertility in both men and women, especially if tumors develop in organs like the ovaries, testes, uterus, or prostate.

“The effect of cancer in men might cause low sperm count and low-quality sperm if the general health is affected by the cancer. In women, similarly, poor general health might affect egg production as well as ovulation,” Dr Chieng explained.

The stress of a cancer diagnosis, coupled with awaiting treatment, can affect libido and sexuality. Additionally, concerns about self-image due to chemotherapy-induced weight changes and hair loss may complicate conception despite technically unaffected fertility.

How do cancer treatments affect fertility?

In many cases, cancer treatments, rather than the cancer itself, pose a greater risk to fertility. Chemotherapy drugs and radiation therapy, mainly targeting reproductive organs, can affect sperm and egg production and quality. 

Similarly, radiation therapy, primarily when directed at or near reproductive organs, can damage their tissues and affect fertility.

“The treatment of cancer includes therapies that are toxic to gamete production. Gonadotoxic therapy is one example. These agents could affect sperm production as well as reduce ovary reserves in some cases,” he added.

Hormonal imbalances caused by cancer and its treatments can further disrupt reproductive function, impacting ovulation, sperm production, and overall fertility.

Despite the challenges, conceiving after cancer treatment is possible, especially if the individual achieves complete remission, according to Dr Chieng.

“Pregnancy post-treatment typically does not complicate matters if the patient's health is stable and if the cancer surgery has not removed part or all the reproductive system. There are usually no health implications if a patient becomes pregnant during or after cancer treatment ends,” he added.

Think about your fertility before cancer treatment

It's understandable to feel overwhelmed at the time of diagnosis and may not consider fertility preservation. Nonetheless, it's crucial to explore your options when you're ready to start a family after cancer treatment.

First, there are prospects of natural fertility without any fertility preservation procedures.

“In cases of young women with cancer, egg production, and normal menstruation might be affected only during chemotherapy, but all these have a high chance of recovery soon after chemotherapy. However, this might not be true in older age groups where menses and ovary functions might not return such as after age 40,” Dr Chieng explained.

Next, chemotherapy types vary in their impact on fertility, from minor to severe, notes Dr Chieng.

Lastly, timing is vital; fertility preservation, like egg cryopreservation, takes time, potentially affecting cancer progression.

“For example, in breast cancer patients who require egg cryopreservation, it may take up to two weeks for fertility preservation to be completed and this delay could potentially affect the cancer progression,” he advised.

It is, hence, essential, especially if you are younger and wish to have a baby sometime in the future, to discuss fertility preservation options with your oncologist and fertility specialist before your treatment begins.

What are the Fertility Preservation Options

Whether newly diagnosed or a long-term survivor, there are now more fertility preservation options to help fulfil parenthood aspirations post-cancer.

For men, sperm cryopreservation before chemotherapy is available since both chemo and radiotherapy can affect sperm production. It's crucial to collect sperm before treatment, as once you begin either of these treatments, the sperm may already carry genetic damage, making it too late to collect and preserve your sperm.

A private room is provided for sperm collection and freezing with a protective solution. In cases of absent sperm due to illness, a testicular biopsy may be performed under general anesthesia.

For women, the options include egg cryopreservation or freezing, embryo cryopreservation, and ovarian tissue cryopreservation, each suited to different patient needs.

“Egg cryopreservation is suited for single women but if the person is married, I would recommend embryo cryopreservation. The embryos can be stored, frozen, and thawed very well. Ovarian tissue cryopreservation would be best considered if the cancer treatment has to start immediately. However, this requires a laparoscopic operation to retrieve the ovarian tissue for preservation,” Dr Chieng said.

Egg (or Oocyte) freezing is when a female's eggs (oocytes) are retrieved, frozen in liquid nitrogen, and stored for future use.

Success rates vary depending on egg quality, ovarian reserve, and age. It is never 100%. However, fertility preservation options help to increase the likelihood of becoming a parent compared to patients who undergo cancer treatment without fertility preservation.

Virtus Fertility Centre Singapore provides both sperm and egg-freezing options to patients.

Patient Suitability

As survival rates for childhood and young adult cancer patients improve, patients are looking to enhance their quality of life after cancer survival. Unless premature ovarian insufficiency occurs, fertility preservation plays a vital role in post-treatment procreation.

“All patients should be offered fertility preservation before cancer therapy. No patients should be denied this option,” Dr Chieng said.

The fertility preservation option might not be suitable for patients who are frail due to cancer at the time of presentation.

“Such is the case of egg preservation or embryo preservation which requires a period of medicine stimulation and procedures for egg collection. It is not suitable for patients who need to start cancer treatment immediately,” he explained.

Keep the Family Planning Conversation

Hence, for cancer patients who are looking forward to starting a family, the fertility discussion should continue with cancer treatment, given the limited reproductive lifespan of many female patients.

Navigating fertility preservation amidst a cancer diagnosis and treatment requires careful consideration of various factors. Understanding cancer's impact on fertility and available preservation options allows you and your partner to make informed decisions to safeguard your reproductive future and realise your aspirations of having a baby.

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