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Author: Sameera Rangwala, M.S., M.P.H.

Being a young adult is a time of immense possibility. It’s a time to explore your passions, build relationships, and start thinking about a family. So, a cancer diagnosis can feel like a huge detour. You might need more space between treatments and recovery to consider the future. But one thing many young adults facing cancer worry about is their fertility as cancer treatment can impact their ability to have children. The good news is that fertility preservation options are available, and we’re here to walk you through the causes of possible infertility and options for the preservation of this precious function.

Causes of Infertility

Cancer treatment can affect a young adult’s fertility through several mechanisms. It’s important to remember that the specific impact on fertility depends on the type and stage of cancer, the type and dosage of treatment received, and individual patient factors. Discussing your concerns with your doctor for a personalized assessment is always best. Here’s a more detailed breakdown: 

Damage to Reproductive Organs

Surgery:

• Pelvic surgeries: Procedures like radical hysterectomy (removal of the uterus, cervix, and upper part of the vagina) for cervical cancer or pelvic exenteration for some advanced pelvic cancers directly eliminate reproductive organs.
• Testicular surgery: Depending on the stage and type of testicular cancer, surgeons might remove one or both testicles (orchidectomy). While sperm production can still occur in the remaining testicle, fertility may be impacted.
• Ovarian surgery: Procedures like oophorectomy (removal of the ovaries) for ovarian cancer eliminate egg production entirely.

Radiation Therapy:

• Ovaries: Radiation directed at the pelvic area can damage the ovarian follicles containing immature eggs (oocytes). This can lead to a decrease in the number of eggs available for ovulation, potentially causing infertility or premature menopause.
• Testes: Radiation therapy to the pelvic region can damage sperm-producing cells (spermatogonia) within the testes. This can lead to reduced sperm production, decreased sperm quality (motility, morphology), or even complete absence of sperm (azoospermia).

Chemotherapy:

• Chemotherapy drugs work by targeting rapidly dividing cells. Unfortunately, this can also harm the rapidly dividing cells responsible for egg (oocytes) and sperm (spermatogonia) production. The specific impact depends on the type and dosage of chemotherapy drugs used. Some drugs are more gonadotoxic (damaging to reproductive organs) than others.

Hormonal Disruptions

• Gonadotropin-releasing hormone (GnRH) agonists: These medications are sometimes used in cancer treatment to suppress hormone production from the ovaries or testes. While temporary, this suppression can disrupt ovulation and sperm production.
• Direct impact on hormone-producing organs: Cancers of the pituitary gland or hypothalamus, located in the brain, can affect the production of hormones like FSH (follicle-stimulating hormone) and LH (luteinizing hormone) needed for ovulation and sperm production.
• Changes in sex hormone production: Certain cancers can affect the production of estrogen (females) and testosterone (males), which play a crucial role in fertility and overall reproductive health.

Photo by Thirdman

Preservation Options

Fertility preservation encompasses a variety of medical procedures designed to safeguard your ability to conceive. It might not be the first thing on your mind during this challenging time but know you have choices. The success rates for these procedures are generally highest when done before starting treatments like chemotherapy or pelvic radiation. However, depending on your specific diagnosis and treatment plan, some options might still be a possibility after treatment has begun.

Here’s what you should know about the different options that are available:

Females

• Embryo Cryopreservation: This involves a multi-step process:

1. Ovarian Stimulation: Medications are administered to stimulate the ovaries and promote the development of multiple mature eggs (oocytes).
2. Oocyte Retrieval: A minimally invasive procedure using ultrasound guidance to collect mature eggs from the follicles within the ovaries.
3. In Vitro Fertilization (IVF): The retrieved eggs are fertilized with sperm (from a partner or donor) in a laboratory setting.
4. Embryo Cryopreservation: The resulting embryos are frozen at a very low temperature using vitrification for future use in IVF cycles.

• Oocyte Cryopreservation: This technique is similar to embryo cryopreservation, but the retrieved eggs are frozen unfertilized. Young women who haven’t yet met a partner or wish to avoid using donor sperm might prefer this option.
• Ovarian Tissue Cryopreservation is an experimental approach that involves laparoscopically removing a small piece of ovarian tissue containing immature oocytes. The tissue is then cryopreserved for potential future use. Techniques are still developing to mature these immature eggs within the frozen tissue or transplant the tissue back into the body to allow for natural ovulation.

 Males

• Sperm Banking: This method is simple and widely used. A semen sample is collected through masturbation and cryopreserved using vitrification for future use in techniques like IVF or Intrauterine Insemination (IUI).

Facing a cancer diagnosis and fertility concerns can feel overwhelming, but know this: you’ve got options, and there’s no pressure!  Think about if parenthood is in your future, explore the different fertility preservation methods (your comfort level matters!), and speak with your oncologist and a reproductive endocrinologist (oncofertility specialist) who can create a personalized plan and guide you every step of the way. Remember, there are tons of resources and support groups out there for young adults like you, so don’t hesitate to reach out – you are absolutely not alone.

Real Stories

There are many personal stories that share about fertility preservation, which are a great place to start learning more if it’s something you’re considering.

• We hear from Gautami, Matt, and Ariane – all cancer survivors who faced the fertility question. They share their experiences and what helped them make decisions about fertility preservation. This video is for anyone facing cancer and wondering, “Can I still have a family?”.
• How We Dealt with Fertility Preservation in Cancer | Ariane, Matt & Gautami’s Story | Patient Voices
• A heartwarming story about a teenage basketball player named Blaine Lowell who is battling cancer. Blaine is being treated at Riley Hospital for Children, which offers a unique fertility preservation program that is helping him keep his dream of having a family alive. Teen utilizes fertility preservation program during cancer treatment
• Paige, who was diagnosed with cancer, talks about her experience going through fertility preservation and how she found support during this difficult time. Paige decided to freeze her eggs because cancer treatment can make it difficult to have children in the future. She also talks about the emotional challenges of treatment and how she found support through social media.
• Freezing My Eggs During My Cancer Treatment | Paige’s Fertility Preservation Story (Lymphoma)

At Here To Serve, we know a child’s cancer diagnosis can bring up many worries, including concerns about having children in the future.  While we don’t directly offer resources for fertility treatments, our support can help ease the financial burden of cancer treatment. This may allow you to explore fertility preservation options you might not have otherwise considered.  Please reach out to Here To Serve. We’re here to listen and explore ways we can support your family during this difficult time. Click here to get the support you need!

Resources and References:

• American Cancer Society: https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer.html
• National Cancer Institute: https://www.cancer.gov/
• American Society for Reproductive Medicine: https://www.asrm.org/
• FertilityIQ: https://www.fertilityiq.com/
• Alliance for Fertility Preservation: https://www.allianceforfertilitypreservation.org/
• Huang, A. J., & Berg, W. K. (2023). Telehealth: Disparity and disappointment. Fertility and
• Sterility. https://doi.org/10.1016/j.fertnstert.2023.06.036
• Latest Techniques in Male Infertility Diagnosis – Shukan Hospital and IVF Center: https://shukanhospital.com/latest-techniques-in-male-infertility-diagnosis
• Hysterectomy – Obstetrical & Gynecological Associates of Des Moines: https://www.obgyndm.com/services/hysterectomy/
• UCLA Health: https://www.uclahealth.org/medical-services/obgyn/fertility
• Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fertility-procedures
• Mayo Clinic: https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 

About the Author: Sameera Rangwala, M.S., M.P.H.

With over 15 years of experience in the biotechnology industry and a passion for science education, Sameera Rangwala is a life science educator who actively engages with the cancer community through her informative blog posts and words of encouragement.

Please note: This blog post is for informational purposes only and should not be taken as medical advice. Always consult a healthcare professional for diagnosis and treatment of any medical condition.