Cancer treatment affects fertility in females: Informs doctors

Cancer treatments are important for improving one’s quality of life after cancer, but they may take a toll on the reproductive organs ad and glands related to fertility. A woman can become infertile and the changes to her fertility may be temporary or permanent. One will have to speak to the fertility consultant before undergoing cancer treatment and opt for egg freezing that can help her become pregnant in the future and fulfil her dream of motherhood. Cancer strikes when cells divide and multiply much faster than most normal cells. Chemotherapy, radiation therapy, and surgery can have many side effects and tend to increase the risk of or cause infertility. Infertility is the inability to achieve pregnancy. Cancer treatment can damage the ovaries, fallopian tubes, uterus, and cervix that are involved in reproduction.
 
Dr. Prashant Mullerpatan MS, FRCS Consultant Oncosurgeon, Apollo Spectra Hospital, Mumbai, said, “A woman diagnosed with cancer will have to either take chemotherapy, radiation therapy, hormone therapy, surgery, or a transplant. Her treating doctor will decide the line of treatment for her. But a woman needs to clear all her doubts regarding the potential side-effects of the treatment as one can even become infertile. Chemotherapy impacts the ovaries, and they can stop releasing eggs or estrogen and this can be known as primary ovarian insufficiency (POI). This condition will be for a short period of time and one’s menstruation will regularize and fertility may be restored after the treatment. But, in many cases, the damage to the ovaries is irreversible and there will be infertility on a permanent basis. So, a woman an exhibit symptom such as hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. The healthy eggs can get depleted in the ovaries due to chemotherapy.”
 
 Dr. Richa Jagtap, Clinical Director & Consultant Reproductive Medicine, NOVA IVF Fertility, Mumbai said, “A woman’s fertility depends on whether her reproductive organs are working properly. If a woman is unable to conceive for around 12 months after regular sexual activity, then she is considered infertile, and after 6 months, if the woman is above 35. Chemotherapy, radiation therapy, or surgery damage ovaries which store eggs, and the ovarian reserve decreases. Women are born with an infinite number of eggs, but when the eggs are lost, they cannot be replaced and there can be infertility and early menopause. To become pregnant after cancer treatment poses a challenge. Chemotherapy and Radiotherapy especially work to deplete the growing cells in the body. Unfortunately, this impacts the eggs and sperms also. Eggs are impacted more severely as the number of eggs is finite. Once lost, the eggs cannot be regenerated. Post cancer therapy a woman should have normal menses, AMH levels of acceptable range, at least 1 healthy ovary, a healthy uterus and one healthy Fallopian tube.  Your ability to become conceive will also depend on your age, the location of the tumour, and the kind of treatment you have been advised. We had 7-8 patients who came with diagnosis of some form of cancer. Some of them could act timely and preserve their fertility. Others were either in age range that outcomes were expected be poor or were unable to afford the treatment. Most of these patients were in age group of 30-44 years.We had a cervical cancer patient, who underwent operation to remove uterus and then plan further radiotherapy. Luckily, she was in time to freeze her embryos BEFORE cancer treatment and can look forward to having her biological child when she is ready.”
 
Dr Richa added, “Egg freezing (oocyte cryopreservation) is a procedure wherein eggs are grown, taken out from the ovary and then frozen.  Later the eggs can be thawed, fertilized with sperm in the laboratory to form embryos, and placed in a woman’s uterus to help her become pregnant. Every woman who wishes for fertility later and is planned for cancer treatment now, should consider egg freezing as a viable option. It's very important to note that egg freezing should be attempted BEFORE the chemotherapy starts. 
 
Dr Veena Aurangabadwala, Gynaecologist, Zen Multispeciality Hospital, Chembur said "Cancer treatment can have an adverse impact on the reproductive function.  Chemotherapy and radiation take a toll on the reproductive organs. These treatment options help to kill cancer cells in the affected organs, but also damage healthy, normal cells of other organs required for the other functions in the body. Ovarian cancer can occur at younger ages too, and may damage the ovaries and reduce their capacity to produce healthy eggs. Uterine cancer usually affects women in ages between 40-70 yrs, affecting reproductive aged women less frequently. In a standard surgery for uterine or ovarian cancer, the doctor may have to remove these organs which may cause infertility. 
 
Since chemotherapy is given via the Intravenous route, it has an impact on all the body organs. Some of these effects reverse with time, after the course of chemotherapy gets over. Radiations from the radiotherapy usually affect the organs adjacent to the target organ where the radiotherapy is directed to. Young women who are affected by blood cancers or intestinal cancers, requiring chemo/ radiotherapy do face fertility issues, as a side effect of their treatment. During the pandemic, we have come across 3-4 young women in their 20s and 30s, who have developed poor ovarian reserve or absence of menses, as an impact of the chemotherapy they received for other systemic cancers, such as colorectal cancer or GIST tumour.  This number is bound to increase in the future decade, as the incidence, awareness and treatment options for cancers in reproductive aged women is increasing. With advancing science, the methods and options for preservation of fertility, such as medical ovarian suppression, egg banking, egg/ embryo freezing, ovarian tissue preservation and ovarian transposition have developed and are available. An expert will have to decide about a plan of action to preserve fertility in women with cancer,” says Dr. Veena Aurangabadwala. 
 
Dr Mullerpatan added, “Radiation therapy given near the areas like abdomen, pelvis, or spine will impact the reproductive organs around that area like ovaries. Radiation therapy to the brain can also harm the pituitary gland that sends signals to the ovaries to make hormones such as estrogen which is required for ovulation. Surgeries done to tackle cancer of the reproductive system or cancer in the pelvis region can harm nearby reproductive tissues cause scarring, and affect fertility. Hormone therapy can disrupt one’s menstruation process and fertility issues. Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation can also give a tough time to women and cause infertility.