Understanding Oncofertility

Infertility is not a guaranteed side effect of cancer treatment; some people go on to get pregnant with no problem after cancer treatment while others face difficult fertility challenges. Some of the factors that influence the odds of fertility after treatment include age, menstrual and fertility history, and the type of cancer and treatment. Cancer treatments and their fertility effects may include:

✓ Surgery: Surgeries to remove entire reproductive organs can cause infertility, such as removal of the uterus, fallopian tubes, cervix, or both ovaries. Surgeries in the abdomen or pelvis near reproductive organs can also affect fertility. For example, if scar tissue builds up around the fallopian tubes or ovaries, this can negatively impact the ability to get pregnant.

✓ Radiation: Radiation in the abdomen or pelvis can damage reproductive organs depending on the dose and target area. Radiation to the brain can also affect the pituitary gland, which signals hormone release to the ovaries for ovulation.

✓ Chemotherapy: Certain chemotherapy drugs have a higher risk of damaging the ovaries, particularly a group of drugs known as alkylating agents. Chemotherapy drugs may lead to a shorter fertility window and result in early menopause

✓ Hormone Therapy: Certain hormone therapies used for various breast cancers can affect fertility, but the effects can be reversible after treatment.

Some people still have periods during treatment with high-risk radiation or therapies. Even though periods do not mean fertility, people who could become pregnant during cancer treatment should take birth control measures. 

With cancer treatment, time is often of the essence. Understanding the reproductive health implications of a treatment plan is important before beginning any therapy, but it may not feel like there is time to wait. A person who elects fertility preservation will ideally have the procedure before cancer treatment begins.

For people with testes, freezing sperm is straightforward and can be quickly performed at many fertility clinics and sperm banks, including Boston IVF.

For people with ovaries, freezing eggs, embryos, or ovarian tissue are options that can be initiated quickly and completed in just a couple of weeks. At Boston IVF, a reproductive endocrinologist with expertise in oncofertility will consult with a person with cancer who wishes to explore fertility preservation within 72 hours of referral.

Some people may be able to have a fertility preservation procedure after cancer treatment begins depending on the type of cancer and treatment plan.

Fertility preservation is not mandatory for adolescents and young adults diagnosed with cancer. People decline fertility preservation for multiple reasons, such as their desire to start cancer treatment immediately, their lack of desire to have children or have more children, or even, unfortunately, the cost of treatment, though more insurance providers cover this important service all the time.

If a person does not preserve fertility and decides to have children in survivorship, parenthood is still possible, whether through natural pregnancy, infertility treatment, surrogacy, or adoption.