Female Fertility Preservation

In female infertility, a woman cannot get pregnant or maintain a pregnancy after a year of trying. There are many different causes of infertility in cancer patients. Discuss your risks with your doctor before treatment begins or as soon as possible. Set up an appointment with your gynecologist or another member of your health care team to discuss your fertility concerns or questions. Ask for a referral to a fertility clinic or specialist for expert help.

Possible causes for infertility in female cancer patients include:

• Treatment that directly affects the reproductive organs.
• Surgery that removes the uterus, fallopian tubes or ovaries.
• Radiation treatment directed to cancer in the abdomen.

The possibility of infertility can affect you emotionally. Thinking about it can result in feelings of sadness or being upset. However, it's important to get help with fertility preservation as soon as possible. Your health care team can refer you to a licensed counselor who can help you through the experience.

Effects of Chemotherapy on Fertility

Some chemotherapy medicines can cause infertility. These types of medicines may be used to treat many different kinds of cancer, not just cancers that affect the reproductive organs. Chemotherapy may reduce the number of eggs in the ovaries or cause early menopause. Menopause happens when menstrual periods stop because the ovaries run out of eggs. If you are in menopause, it means there are no eggs left or that the remaining few eggs are not healthy.

The table below lists some of the chemotherapy medicines that can damage ovaries. Discuss this table with a member of your health care team.

Symptoms of Infertility

Some women don't realize that fertility has been affected until they try to have children and are not able to get pregnant. The following are some symptoms of infertility. However, these could be symptoms of other medical conditions as well.

Talk to your doctor if:

• Your menstrual cycles are not regular.
• You are having hot flashes.
• It hurts when you have sex.
• You have been trying but have not been able to get pregnant.
• You have had several miscarriages.

Menstrual Cycle: Female cancer survivors who reached puberty before starting treatment often stop menstruating during treatment. This isn't necessarily a sign of infertility. A woman’s period should return within six months of completing treatment. If it hasn't returned within a year, there may be concerns about infertility. Keep your doctor informed about your menstrual cycle. It's important to find out if there is a physical problem that needs treatment.

Menopause: Your health care team may want to run tests to find out if you are experiencing premature or immediate menopause. Infertility can happen after menopause or in the few years preceding it because there are no eggs left or the remaining few eggs are not healthy. The Follicle Stimulating Hormone (FSH) measurement test determines if a woman is in menopause. If FSH levels are high, there may be a need to use donor eggs to get pregnant.

Damage to ovaries: Your health care team may check your fallopian tubes and uterus to determine whether there is damage to these organs that might cause infertility. Damage to ovaries can happen with pelvic or abdominal surgery for cancer.

Some survivors still have healthy eggs and can easily get pregnant after treatment, but they may have problems carrying the baby to full term. This usually is not because of cancer treatment. However, it's a problem that should be discussed with a gynecologist.

Family Building Options After Treatment

There are options for cancer survivors who have already experienced infertility as a result of cancer or treatment. Talk to your health care team. Ask them to help you find a fertility specialist who can talk to you about your options. You can also contact Livestrong Cancer Navigation Services for guidance through the experience.

If you've already finished cancer treatment and are thinking about fertility for the first time, set up an appointment with your oncologist. Discuss your past cancer treatment and any possible effects on your fertility. If you are at risk of being infertile, your oncologist can refer you to a good fertility specialist for help.

___

Works Cited

Oktay K and Karlikaya G. Ovarian function after autologous transplantation of frozen-banked human ovarian tissue.N Engl J Med, 342:1919, 2000.

Oktay K., Economos K, Rucinski J, Kan M, Veeck L, Rosenwaks Z. Endocrine function and oocyte retrieval after autologous transplantation of ovarian cortical pieces to the forearm. JAMA, 286:1490-1493, 2001.

Oktay K, Buyuk E, Davis O, Yermakova I, Veeck L, Rosenwaks Z. Fertility preservation in breast cancer patients: In vitro fertilization and embryo cryopreservation after ovarian stimulation with tamoxifen. Human Reprod 2003; 18(1):90-95.

Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol. 1996 May; 14(5):1718-29.

Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update. 2001 Nov-Dec; 7(6):535-43.

Goodwin PJ, Ennis M, Pritchard KI, Trudeau M, Hood N. Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol. 1999 Aug; 17(8):2365-70.

Table. Cytotoxic agents according to degree of gonadotoxicity