Fertility and Cancer Diagnosis
Today let’s talk about a topic that is less popular either by design or due to collateral of the bigger issue, which is a Cancer diagnosis.
Many young women continue to be diagnosed with cancers such as breast cancer worldwide. This is partly due to early detection, genetic predisposition, or improved health-seeking behavior in educated women. Nonetheless, the gaps remain in women with no formal education, low social and economic status, and lack of cancer care access, including information and resources about cancer, lack of community-based cancer awareness programs, and conflicting social and economic challenges in low- and middle-income countries, leading to delay of timely diagnosis.
How often do you hear cancer patients discuss their desire to have children or complete their family? How many doctors have these conversations with their patients during or before cancer treatments? What are the side effects of cancer treatments such as chemotherapy, radiotherapy, or even surgery?
These are poignant questions that are and should be an integral part of holistic cancer diagnosis and treatments.
Let’s dive into how such cancer treatment modalities affect the fertility of a woman or a man.
Tumor cells are rogue cancer cells that are dividing rapidly, a.k.a “all gas no brakes,” which defies the natural cell cycle patterns that many dividing healthy cells such as hair, nails, and your blood cells follow- i.e., a cell is born, does its job and dies a natural death in a tightly controlled cellular microenvironment. That’s why your hair follows an organized pattern of growth and regrowth after shaving, and so are your nails. Also, these are the reason why the dreaded “hair falling” during chemo happens.
Doctors take advantage of the inability of cancer cells to repair their DNA timely compared to healthy cells. Chemotherapy kills these tumor cells, but with the collateral damage of equally fast-dividing cells, as I mentioned above (hair, nails, gut cells). However, our healthy fast-dividing cells have intact DNA repair machinery, which cancer cells don’t have; hence cancer cells cannot repair themselves timely after treatment. This is the Achilles heel of cancer cells and the concept behind the discovery of cancer treatment with chemo drugs.
Now, equally fast-dividing and highly chemo-sensitive cells are the ovaries which are reservoirs and the powerhouse of female fertility. Chemo drugs kill the mature ovarian follicles, a.k.a eggs (released every month), and even the primordial small follicles (next in line for release), wiping out the ovarian reserve.
Similarly, radiotherapy works by using high-energy X-rays used to destroy cancer cells. Radiation can affect a woman's fertility. If a female patient is receiving radiation therapy to the abdomen and pelvis, depending on the radiotherapy dose can destroy some or all of the eggs in the ovaries and can cause female infertility or early menopause. Radiation can also cause scarring of the uterus, which reduces blood flow to the uterus and also prevents the uterus from fully dilating during pregnancy. Women who have had radiation therapy to the uterus have an increased risk of miscarriage, low birth weight, and premature birth. (1)
The younger the patient, the more eggs will be in the ovaries. This gives the patient a better chance of preserving fertility. Women who receive cancer treatment before the age of 35 have a fairly high chance of becoming pregnant after treatment. Some younger patients may stop menstruating during chemotherapy. But after stopping treatment for a while, the patient's periods may start again.
Some ways fertility is preserved in a woman who desires to have children after cancer diagnosis and treatment include harvesting the eggs before treatment and freezing them for later use through assisted fertility procedures. Another technique is to give hormonal drugs that put the ovaries to sleep temporarily to reduce the insult of chemo on the ovaries and, by extension, the follicles (which can be reversed after treatment)
As for men, similar techniques are employed in which sperm is collected before treatment and stored for later use through assisted fertility procedures. Men should be advised of a potentially higher risk of genetic damage in sperm collected after initiation of cancer treatment.
All oncologic healthcare providers should discuss infertility as a potential risk of cancer treatment as soon as possible once a cancer diagnosis is made. There are benefits for patients in discussing fertility information with providers at every step of the cancer journey(2)
It’s also important to seek counseling for such difficult discussions surrounding the double anxieties of cancer diagnosis and childbearing. Still, the right information can go a long way in shaping the informed decisions of patients and their families.
About the Author
Dr. Omar Abdihamid is Clinical Oncologist from Kenya. He is passionate about Global Oncology and cancer care equity in low- and middle-income countries. His main areas of interest are culturally based cancer care, patient education, and cancer care advocacy. Dr. Omar is a scientific writer, a published cancer researcher, and a reviewer for cancer journals. He is a fellow of the ASCO 2023 IDEA award, the recipient of the 2021 Journal of Global Oncology editorial fellow program, and a winner of ASCO Voices 2022.
1. Center MAC. Fertility and cancer: 10 things to know.
2. Anderson M. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update.