Getting a diagnosis of cancer is tough enough without having to also stress about the effects of treatment on your fertility. This section of our web site is designed to ease this stress and to quickly give you important information about the effect of cancer therapy on your fertility.
If you have found your way to this section of our web site most likely you are either a recently diagnosed patient or a health care provider trying to give information to your patient. The most likely diagnosis to get you here is breast cancer, lymphoma or leukemia for women. For men the most likely diagnoses are lymphoma, leukemia, or testicular tumor. For both men and women sometimes kidney diseases will require chemotherapy. Also some women with severe arthritis will require this treatment.
You are not alone. Fortunately survival from cancer is now a common event. We have consulted with many an individual in the same exact circumstance. The good news we have to share with you is that we have been able to help in some way in most cases. We have also been fortunate to see the patients after treatment and to help them to start or complete their families.
There are two common types of cancer treatment that can affect fertility: radiation and chemotherapy. How much effect your treatment will have on your future fertility depends on a number of factors including: gender, age, stage of puberty, and total dose.
If you do not know the type or dose of chemotherapy you will be receiving, ask your doctor or nurse to use the calculator to estimate your risk of infertility in the future. The following is some general information you can use.
The testes are particularly sensitive to radiation. If the tumor is not testicular, they can be shielded. Doses of less than 100 Rads will give some decrease in sperm numbers and doses of more than 200 Rads will produce long term or permanent damage.
Chemotherapy will produce variable declines in sperm counts. The alkylating agents such as Cytoxan are the most damaging. Doses of Cytoxan in excess of 14 grams produce long-term damage. It is also known that the damage for children prior to puberty is less than that for adults.
Fortunately for men, sperm freezing and storage are readily available in most communities. Long-term storage is also a viable option and the cost is modest. If you would like to freeze your sperm you will not need to see us in consultation. Your oncologist or primary care physician can call the Christ Hospital reproductive studies lab at (513) 585-0990 and order the freezing. The lab will require testing you for Hepatitis B, C, and HIV in order to store the sperm. The cost to freeze one specimen is $170 and $100 per year for storage. Ideally you will want to freeze 2 or 3 specimens a few days apart. Having more sperm on hand in the future will give you more options for future reproduction. One specimen may not be enough for all your future needs. Studies have shown that sperm from men with cancer has lower count and motility possible due to stress on the body. In most cases it can be used in the future for insemination or in vitro fertilization.
Cancer therapy tends to affect the ovaries more than the uterus. That is because the egg supply depletes naturally during reproductive life. The uterus renews its lining every single menstrual cycle. Radiation of the reproductive tract can affect the ovaries and uterus. Chemotherapy tends to only affect the ovaries. Radiation doses of up to 150 rads cause mild damage. Doses of up to 250 rads cause moderate and more than 500 rads cause severe damage.
Chemotherapy’s effect on fertility depends on how old you are, what agent you are going to receive and what the total dose is. The harshest agents on the ovaries are the so-called alkylating agents. These include cytoxan, chlorambucil, melphalan, busulphan, nitrogen mustard, and procarbazine. Less toxic are cisplatinum and adriamycin. The least toxic are methotrexate, 5-FU, vincristine, actinomycin D and the taxanes.
What can a woman do to preserve her fertility? First of all remember that your age is a major factor. If you have not gone through puberty, your ovaries are inactive and will suffer less from the effects of chemotherapy. If you are less than age 35 your ovaries have more eggs and therefore will retain more function after the chemotherapy.
Some studies have shown that treatment with a drug called a GnRh agonist will shut down your ovaries and render them mores resistant to chemotherapy. One commonly used agent in the US is DepoLupron which is a monthly shot that puts the ovaries in a state of rest. The usual dose is 3.75 milligrams given intramuscularly every month while you are on chemotherapy. If you would like this treatment you do not need to see us since most oncologists are familiar with this medication. The ideal time to take this medication for the most rapid shut down is after ovulation if you definitely know that you cannot be pregnant or anytime you are on birth control. Otherwise it has to be given during menstruation when we know you could not be pregnant. Side effects of Lupron are hot flushes and mood swings. The drug causes a reversible “medical menopause”. Once the medication is stopped your cycles should return. Remember this protection is not 100% but it is something that can be done more easily.
Now for some more complicated things. It is possible if you are married or have a partner to do in vitro fertilization (IVF) and freeze the embryos for future use in case your ovaries fail after chemotherapy. This process is readily available but is complex and expensive. It will take at least 2 weeks to stimulate and extract the eggs and fertilize them. The embryos are then saved for use when you are finished with cancer therapy. Embryos have been stored for more than a decade without affecting their ability or produce healthy live births. The advantage of this approach is that if your ovaries fail after treatment you have a fall back position. The cost of IVF if high and it is usually difficult to get insurance to agree to cover it. Our program is less expensive than most. The procedure cost starts at around $8000. You will also need about $2,000 of medication. We do participate in Fertile Hope which is an organization that offers discounts for cancer patients. This can reduce the procedure cost and in some cases provide medication for free.
What about egg freezing? Unfortunately it is harder to freeze eggs than sperm or embryos. The structure of the egg is microscopically different. The number of births in the world from frozen eggs is till quite small. The most promising technique is actually not freezing per se but is vitrification or solidification. Our center is involved in an egg vitrification study and has generated one live birth from this procedure. Following the recommendation of the American Fertility Society, we cannot yet offer this technique as a routine procedure. We think within a year we will be able to offer it. Egg freezing would be simpler and more desirable particularly for a single woman or a child.
What if you go though cancer treatment and then run out of eggs? Are there options then? Fortunately, the answer is yes! We have an excellent donor egg program where women will donate eggs to other women. The process is not simple or inexpensive but it is readily available and highly successful.
We sincerely hope this information has been helpful to you. The Institute for Reproductive Health and its staff wish you the best of luck with your treatment. We are happy to help you or your doctor in any way during this understandably difficult time.