by Elise Frame
June is World Infertility Month, so we’re highlighting some of the resources and key information about cancer and infertility available on our website under We Can Help. You can also call 1-855-220-7777 to speak one-on-one with a LIVESTRONG Navigator, or fill out our online intake form.
When you’re first handed a cancer diagnosis, it can feel like a multitude of complicated information has just been dumped on you all at once — there’s often too much to adequately process and address at one time. Unfortunately, this means important issues and concerns can sometimes slip through the cracks in the interest of treating the cancer right away. One of these issues often overlooked is the risk of infertility that some chemotherapies, surgeries and radiation treatments may cause. LIVESTRONG Fertility Services can guide you to the right resources and information regarding your fertility preservation or family planning options, whether you’ve just been diagnosed, are in active treatment or have already completed treatment.
What is infertility?
Infertility is the inability for you or your partner to become pregnant or maintain a pregnancy after at least a year of trying. Infertility after a cancer diagnosis may develop as a result of receiving chemotherapy drugs known to damage sexual reproductive organs, radiation therapies targeted at or around sexual reproductive organs or surgeries where sexual reproductive or surrounding organs are removed or altered.
For female cancer survivors, infertility is often associated with premature or immediate menopause. This means that the woman’s body no longer produces eggs, and/or that the few eggs remaining are not healthy enough to sustain a pregnancy. A doctor can perform a Follicle Stimulating Hormone (FSH) measurement test to determine if a woman has reached menopause. If her FSH levels are high, she may need to use donor eggs in order to become pregnant. Infertility in women can also be related to removal of or damage to the ovaries, fallopian tubes or uterus.
In men, infertility is related to low sperm count, poor motility or abnormal morphology of sperm. Sperm count is the number of sperm present in a sample, with a normal count being at least 20 million sperm per milliliter of semen. Motility refers to the percentage of sperm that are actively swimming around, which should normally be at least 50 percent of the sperm in the sample. Morphology refers to the shape of the sperm. It is considered normal if at least 30 percent of the sperm have an ideal shape. However, it is important to note that some labs use a different scoring system (Kruger) which is stricter, so only 14 percent of sperm cells must have ideal morphology under that system.
Not all chemotherapy drugs carry the same risks for developing infertility.
While many chemotherapy drugs, especially those with alkylating agents, are associated with higher risks of developing infertility for both men and women, and/or early onset menopause in women, not all drugs will necessarily affect your fertility. Talk with your doctor or ask for a referral to a fertility specialist to evaluate your personal risk factors. You can find more generalized information about potential infertility risk factors among cancer survivors for women here and men here.
Infertility or menstrual cycle irregularity might be temporary.
Sometimes the cancer itself, such as testicular cancer or newly diagnosed blood cancers, can temporarily lower a man’s fertility before treatment begins and right after treatment ends. However, for men who recover sperm production, semen analysis will usually improve one to three years after completing treatment.
Female survivors who reached puberty before beginning treatment commonly stop menstruating during treatment. However, this isn’t necessarily a sign of infertility. A woman’s period should return within six months of completing treatment. If it reaches a year without her menstruation cycle returning, she should consult a gynecologist to access her risk of infertility and to ensure there aren’t any underlying complications. Regardless of whether you are trying to become pregnant or not, it is important to keep your health care provider informed if your menstrual cycle is irregular, you are experiencing hot flashes, having sex becomes painful or if you have had any miscarriages.
Fertility preservation and alternative family planning options are available.
Possible fertility preservation and family building options include:
- Sperm banking
- Testicular tissue freezing
- Egg freezing
- Embryo freezing
- In vitro fertilization
- Intrauterine insemination
- Using donor sperm or eggs
- Using a surrogate to carry the pregnancy
Unfortunately, many of these procedures and options are costly and may not be covered by health insurance. However, there may be grants and other funding available to families considering these options. Contact LIVESTRONG Fertility Services to find out more about these possibilities.