Although fertility problems are fairly well known side effects of cancer and cancer therapy, they are often dismissed as an unfortunate consequence that nobody has any control over. In addition, many people do not realize why or how their ability to have children is impacted by cancer.
The truth of the matter is that while many blood cancer therapies can cause infertility, this is not the case for all treatments, and there may be something you can do about it.
What Causes Infertility in Cancer Patients?
Cancer-related infertility can be temporary or permanent. Your ability to have children can be impacted by many factors:
- the disease itself
- treatment side effects
- type of therapy you receive
- your age
- other medications or health problems you might have
- availability of fertility preservation techniques
- your religious or cultural beliefs about assisted reproduction (eg; in vitro fertilization and the like)
How Do Blood Cancers Effect Fertility
Though more common in people of advanced age, some leukemias and lymphomas often affect young individuals of reproductive age. Many blood cancer patients are at an age where they have not had the opportunity to start, or even think about starting, a family.
In the case of blood cancers, infertility is not usually caused by the disease itself, but more often by its treatment. The exception is Hodgkin lymphoma, which may cause a very low sperm count in males.
How Does Chemotherapy Effect Fertility?Chemotherapy can impact both male and female fertility, but not all medications have the same effect. In men, chemotherapy can cause an absence of sperm in the semen (azoospermia). In women it can cause an inability of the ovaries to release an egg cell (ovarian failure).
For the most part, the total amount of a chemotherapy drug given over the weeks and months of treatment has a greater impact on fertility than the amount of the drug given in a single dose. Combination chemotherapy is more likely to cause damage to the reproductive system than single drug therapy.
In both men and women, the group of medications that are most likely to impact fertility are the alkylating agents. Some examples of alkylating agents include cyclophosphamide, ifosphamide, melphalan, busulfan and procarbazine.
However, since there are many factors which influence fertility in cancer patients besides the medications they receive, it is difficult for specialists to be able to say for certain who will be affected.
How Does Radiation Therapy Effect Fertility?
Radiation therapy is often given in small doses (fractions) over a long period of time to reduce side effects and toxicities. Unfortunately, "fractionation" causes more damage to the reproductive organs than administering one large dose. When administering radiation, every attempt is made to shield reproductive organs when possible.
Even in small doses, radiation to the testes can decrease sperm count. This effect may be temporary or may be permanent if higher doses are used. Radiation may also cause a decrease in testosterone levels.
In women, the ovaries may be directly in the radiation field. In this case, the physician may choose to surgically move the ovary to another area of the body so it less likely to be damaged by the radiation. Young women are more likely than older women to regain their fertility after radiation.
Total body irradiation, as is sometimes used in preparation for stem cell transplant, will usually cause a permanent impairment in fertility of both men and women.
Questions to Ask Your DoctorIt is not uncommon for blood cancer treatment to cause infertility in both men and women. While this may seem like the furthest thing from your mind, it is important that you discuss your fertility options with your healthcare provider as soon as possible after your diagnosis.
Here are a few questions you may want to ask your doctor:
- Is this therapy likely to affect my fertility?
- Do you expect that this side effect will be temporary or permanent?
- Is there anything that can be done to prevent infertility during my treatment?
- Are there other treatment options that are less likely to cause infertility?
- Will I have time before my treatment begins to explore my fertility preservation options?
- Can I be referred to a fertility specialist to discuss my fertility preservation options?
- If I remain fertile, will my future children be affected by my treatment?
- How will I know if I am fertile or not?
Many people who have been faced with a life threatening condition experience a greater appreciation for the gift of life and the ability to create life. There are many different factors that can influence the impact cancer treatment will have on your fertility. In many cases, it is impossible for doctors to predict. While it may be difficult, or even impossible, to get the most effective treatment for your cancer while preventing infertility, there may be options for you to preserve your fertility before beginning therapy.
It is important that you discuss all of your questions and concerns about becoming pregnant or fathering a child in the future before you begin treatment.
Krebs, L. “Sexual and Reproductive Dysfunction” in Yarbro, C., Frogge, M., Goodman, M., and Groenwald, S. eds. (2000) Cancer Nursing: Principles and Practice 5th ed.Jones and Bartlett: Sudbury MA. (pp.831- 854).
Lee, S., Schover, L. Partridge, A. et al. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. Journal of Clinical Oncology 2006;24(18):2917- 2931.