Cancer treatment can impair fertility because

With advances in cancer treatment, cancer survival is increasing and for cancer survivors, quality of life will be important with fertility being an important aspect.

For men, sperm or testicular tissue should be stored before any cancer treatment. For women, a wide range of options are now available, the best one depending on the patient’s age, diagnosis, and treatment modality.

Fertility preserving cancer treatment may be possible in early stages of some cancers. These include conservative surgery for early stage cancer of the cervix or ovary. For early stage endometrial cancer, hormonal therapy may be considered to induce regression of cancer. Otherwise, other options include freezing of embryos (if the patient is married), or freezing of the oocytes (eggs) or ovarian tissue.

Freezing of embryos may be performed if the patient is married. These embryos are obtained through ART or IVF. Hormonal injections are required followed by egg/ oocyte retrieval. The eggs are then fertilized with sperm to form embryos which are then frozen. Frozen embryos may then be thawed for future use. This is a well- established method.

Freezing of eggs or ovarian tissue are considered more experimental methods. However, successful use of frozen eggs and ovarian tissue have been recorded.

Eggs may now be frozen with minimal damage using a technique of rapid freezing called vitrification. Vitrified eggs have been thawed for fertilization to form embryos resulting in healthy pregnancies.

Ovarian tissue may be obtained by minimally invasive laparoscopic surgery. The tissue may then be frozen and later thawed and transplanted back into the patient. This method has also been performed successfully, resulting in several live births.

It is important to discuss each case with the oncologist to determine the safest option. ART/ IVF techniques may expose the patient to unwanted hormonal effects while ovarian tissue cryopreservation involves the need for laparoscopic surgery. Hence, multidisciplinary management is important with close collaboration between cancer doctors, anaesthetists, haematologists and paediatric colleagues.

Pregnancy in theory may increase the risk of cancer recurrence in patients with hormone- sensitive tumours. This is because pregnancy is associated with high levels of hormones produced from placenta. This may be an issue for patients with hormone- sensitive tumours e.g. breast cancer. It is usually advised that breast cancer patients postpone their pregnancy until 2-3 years from the time of diagnosis to reduce risk of recurrence.

Having undergone cancer treatment, there may also be possible effects of previous cancer treatment on pregnancy. With chemotherapy, potential damage to eggs/ sperm following cancer treatment may result in birth defects. With radiotherapy there may be possible effects on the womb and an increased risk of low birth weight babies and preterm labour. Once again, multidisciplinary management is important with close collaboration needed with cancer doctors.

Patients planning to get pregnant should undergo preconception health assessment to determine fitness for pregnancy. This includes assessment of heart, lung and kidney function. Blood tests may be required.

During pregnancy, an early dating scan should be performed and prenatal genetic screening at 11- 14 weeks gestation should be offered. She should also have a detailed fetal anomaly scan at 20 weeks. Serial growth scans are advisable throughout pregnancy.

For delivery, Caesarean section may be necessary. Once baby is born, modern neonatal healthcare facilities should be available to ensure best outcome for the baby.