How Chemotherapy Affects Fertility
Hair loss and nausea are the most talked-about side effects of most chemotherapy drugs. But if you’re in your childbearing years, you may also worry about chemotherapy’s effect on your fertility. You’re right to be concerned. Here’s what you should know:
If you’re receiving chemo for any cancer . . .
Chemo can prevent the ovaries from producing hormones that trigger the release of eggs into the fallopian tubes, so you may not have a period while in treatment, and for several months afterward. It’s important to use barriers methods for contraception while receiving chemotherapy because it’s unwise to conceive during cancer treatment. It can result in birth defects as well as impact the type of treatments you’re then able to have.
So will you be able to conceive again when chemotherapy is completed? Menstruation and fertility typically resume once chemotherapy is completed, notes Dennis Citrin, MD, a medical oncologist at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, IL.
The timing of when to consider having a baby is something to discuss with your medical oncologist. Usually there is a waiting period, typically 2 years, after completion of treatment for cancer before survivors are advised that they can try to conceive. In some situations, the drugs given for your treatment may cause infertility. It’s important to talk with your oncologist about your family plans so that if fertility preservation is something that needs to be considered, it can be proactively addressed before you begin your treatments.
If you’re close to age 45 . . .
Chemo will cause your periods to stop, triggering menopause (even if your body isn’t quite ready for it). As a result, you’ll most likely no longer be fertile. Also, the combination of chemotherapy and hormonal therapy can result in earlier menopause. However, don’t assume that the absence of your menstrual period means you’re not ovulating. You still might be periodically. So use a barrier method while on these medications.
So what are your options?
“Medical science has made major advancements in fertility, and while there isn’t yet a perfect solution, there may be options to remain cancer-free and raise a family,” assures Citrin. Talk to your chemo care team about the following:
Stored eggs: Before cancer treatment begins, you may be able to have your eggs harvested and frozen. That way, you’ll have the eggs if you’d like to try to get pregnant after treatment. In short, about two weeks from the onset of your period, you would give yourself hormone injections and get frequent blood work and ovarian ultrasounds. Upon maturation, your eggs would be retrieved during an outpatient surgical procedure.
For embryo freezing, the eggs are fertilized with sperm and the resulting embryos are frozen. The process can be difficult, and it’s expensive—$5,000 to $8,000 according to the University of Texas MD Anderson Cancer Center—and rarely covered by insurance. Note, too, that the success rate of using stored eggs is much lower than using stored embryos.
Keep in mind that egg harvesting affects hormone levels, which can affect the growth of certain types of cancer, especially in people with breast cancer, says Dr. Citrin. That’s why you may be put on hormonal therapy several years, and ideally five years, before embarking on pregnancy. The bottom line: Your oncologist and fertility specialist need to meet and talk about your specific situation and treatment planning.
Stored embryos: Another option is to stimulate your ovaries to produce more eggs than usual and then fertilize them with sperm from your partner or a donor. The embryos can be frozen and stored for later use. A surrogate can carry the baby if you are unable to do so.
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