Mayo Clinic Q and A: Fertility considerations in cancer treatment: Preserving hope for the future

DEAR MAYO CLINIC: I’m a 28-year-old lady not too long ago recognized with breast cancer. My care group recommends beginning remedy as quickly as attainable. While I’m able to do the obligatory therapies, I’m nervous about the have an effect on it might have on my capability to have kids in the future. Are there choices that may assist protect my fertility throughout cancer remedy?

ANSWER: When a person is diagnosed with cancer, the focus is usually on quick remedy and restoration. However, it is vital to contemplate the long-term results of cancer and its therapies on fertility. These therapies can considerably have an effect on a person’s reproductive organs, doubtlessly altering their capability to have kids in the future.

Cancer and its therapies could cause changes in your body. For some individuals, cancer damages part of the reproductive course of and impacts fertility. For others, the obligatory cancer therapies intervene with fertility. The probability that cancer remedy will hurt your fertility is dependent upon the kind and stage of cancer, the cancer remedy methodology and your age at the time of remedy.

Cancers which have a higher danger of affecting fertility – together with by way of remedy – are breast cancer, uterine cancer, cervical cancer, ovarian cancer, colon cancer, prostate cancer, testicular cancer, thyroid cancer and blood cancers like lymphomas.

Certain cancer therapies can hurt your fertility. The results could be short-term or everlasting.

Cancer remedy and its results may embody:

• Chemotherapy
  This frequent cancer treatment targets and destroys lively cells in the body. The ovaries and testicles, that are very important reproductive organs, comprise a high variety of lively cells and are vulnerable to wreck from chemotherapy. This injury can have an effect on the capability of the ovaries or testicles to supply viable eggs or sperm after cancer remedy, thus affecting fertility. Future fertility is dependent upon numerous elements, reminiscent of the kind, length and dose of chemotherapy, and the affected person’s age.
• Radiation
  This remedy can also have an effect on fertility, primarily when administered in the pelvic space at high doses. In some instances, sufferers could decide to have surgical procedure to reposition the ovaries from the radiation discipline, decreasing the danger of harm.
• Surgery
  Fertility additionally will be harmed by the surgical removing of the testicles, uterus or ovaries.
• Other cancer medicines
  Hormone therapies used to treat certain cancers, together with breast cancer, can have an effect on fertility. But the results typically are reversible. Once remedy stops, fertility could also be restored.

Various fertility preservation choices could also be obtainable for cancer sufferers earlier than they bear cancer remedy.

• Freezing
  For women, egg freezing or embryo freezing are normal practices, with minor variations relying on whether or not the affected person has a associate or intends to make use of donor sperm. These strategies contain hormonal stimulation with injections over a couple of weeks and retrieval of eggs from the ovaries. The eggs will be instantly cryopreserved or blended with sperm for fertilization for the cryopreservation of embryos.
• Cryopreservation
  Another possibility is ovarian tissue cryopreservation, which includes eradicating and freezing half or all of an ovary. The ovarian tissue is split into small strips and cryopreserved for future use. This methodology is especially appropriate for younger girls who have not reached puberty or women who must start cancer remedy instantly. Men could think about sperm cryopreservation, which includes freezing and storing sperm for use at a later date. Testicular tissue cryopreservation additionally may very well be a consideration for boys earlier than puberty.
• Suppression
  Ovarian suppression could also be thought of, however it’s not a confirmed methodology of fertility preservation. Ovarian suppression includes medicines quickly suppressing ovarian exercise, doubtlessly defending the ovaries from chemotherapy’s results.

During cancer remedy, radiation shields can shield fertility in males and women. This process locations small lead shields over the ovaries or testicles to cut back the radiation publicity they obtain. Proton radiotherapy can also protect fertility by delivering focused remedy and minimizing publicity to adjoining organs and tissues.

The prognosis of cancer and the remedy course of will be overwhelming. However, you might have choices in case you’re involved about how cancer remedy may have an effect on your fertility. Don’t wait. Talk together with your care group about fertility preservation strategies earlier than you start cancer remedy that will help you make an knowledgeable alternative. — By Alicia Ogle, OB-GYN nurse practitioner, Mayo Clinic Health System, Eau Claire, Wisconsin, and Jessica Bleess, Reproductive Endocrinology and Infertility doctor assistant, Mayo Clinic, Rochester, Minnesota

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