Following a cancer diagnosis, people generally focus on coping emotionally and choosing the right treatment option. However, doctors point out that younger people diagnosed with cancer need to think about preserving their fertility. This is crucial as several treatment options can affect one’s ability to conceive.
Dr Jyoti Bajpai, professor and lead, medical and precision oncology (Mumbai and Maharashtra region) at Apollo Cancer Centres, says that with the recent advancements in treatment, survival rates have improved. The focus, however, is not solely on survival — it also focuses on their ability to return to their normal lives. “And fertility is a very important biological aspect of this,” she says.
How does cancer affect fertility?
Explaining how cancer treatments like chemotherapy affect one’s fertility, Dr Bajpai says “Chemotherapy, which kills cancer cells, is crucial for [treating] many solid tumors. It targets and kills actively multiplying cancer cells. They also target such active cells in other parts of the body.” Hence, chemotherapy often affects one’s organs, hair follicles, oral mucosa and gonads (glands that produce reproductive hormones”.
Dr G Vamshi Krishna Reddy, director – oncology services, consultant medical oncologist and hemato-oncologist, Yashoda Hospitals, Hyderabad, adds that the effects of chemotherapy can affect the ability to produce viable eggs or sperm, thus affecting one’s fertility after cancer treatment. Several factors, including the type, duration and dose of chemotherapy or radiation and the patient’s age at the time of treatment, dictate the chances of conceiving in the future, he adds.
“There is a substantial impairment of fertility, especially when we use multi-agent chemotherapy [combination of chemotherapy drugs for better clinical outcome],” cautions Dr Bajpai. “The affected people should be counseled upfront and encouraged to opt for fertility preservation,” says Dr Bajpai.
Preserving fertility: The current scenario
Dr Somashekhar S P, global director of Aster International Institute of Oncology and one of the office bearers of The Association of Gynaecologic Oncologists of India (AGOI) points out that around 30% of people with cancer who undergo chemotherapy become infertile.
“In India, cancer often affects people a decade earlier compared to those in the west. Younger adults are often diagnosed with cancer at an age when they are not yet bothered by fertility issues or thinking of family planning,” says Dr Somashekhar adding that cancer diagnosis among young people is only increasing. “Hence, doctors are extra cautious when a young adult is about to start chemotherapy,” he said.
“Before young people start treatment for any form of cancer, we schedule a consultation with an assisted reproductive technology (ART) specialist or infertility specialist. Women also undergo a blood test to assess their ovarian reserve,” he says.
Ways to preserve fertility after a cancer diagnosis
Dr Reddy lists some common ways to preserve fertility before starting on your cancer treatment:
Egg freezing: Also known as oocyte cryopreservation. In this procedure, the affected person’s eggs are retrieved and frozen. They can later be fertilized in a laboratory to form embryos which can then be put in a woman’s uterus.
Embryo freezing: In this procedure, eggs from the ovary are fertilized with sperm in the lab to form embryos. These are frozen and can be used later.
Sperm banking: A relatively easy technique, sperm banking involves collecting, freezing and storing sperm for later use.
Besides, Dr Bajpai shares that the gonadotrophin-releasing hormone (GnRH) analog injection is also effective in reducing fertility impairment in women.
Dr Somashekhar adds that in some cases of cancer in the uterus or rectum, the ovaries are repositioned through robotic or laparoscopic surgery. He shared a recent instance of a 21-year-old female patient with rectal cancer. “Her ovaries and gonads were surgically moved to the upper abdomen before we performed radiation therapy to treat the cancer, which helped preserve fertility,” he says.
Importance of preserving fertility
Dr Bajpai says that counseling someone diagnosed with cancer on their potential fertility options is an important part of cancer treatment plans. “In cases when they are unable to grasp this, we re-counsel them on their next visit,” she says.
She adds that those with cancer should meet their specialist as early as possible and execute the most viable fertility option. She explains that while fertility might be the last thing on their minds while they prepare to overcome cancer, people tend to think of it once they are in remission. Dr Bajpai, who earlier worked in Tata Memorial Hospital, Mumbai, India’s largest cancer center, and mainly treated breast cancer and sarcoma cases which largely affect younger people, shares that with fertility preservation methods, many cancer survivors went on to become parents, which was highly gratifying to witness.
Takeaways
While navigating a cancer diagnosis can be difficult, doctors say it is important to think not only about treatment and survival but also about how to preserve your fertility, especially if you’ve been diagnosed young. Chemotherapy and radiation therapy, among other forms of cancer treatments, can end up affecting one’s ability to conceive. From egg and sperm freezing to embryo freezing and injections, several options can help preserve fertility.
