Cancer Treatment and Fertility

Cancer treatment and fertility at a glance

• The cancer treatments chemotherapy, radiation, targeted therapy, immunotherapy and surgery can all cause infertility in men and women.
• Patients diagnosed with cancer may choose a fertility preservation procedure such as egg freezing, embryo freezing or sperm banking so they can retain the option of having children after cancer treatment.
• Cancer treatment can cause infertility in women by damaging the eggs and ovaries, and in men by damaging the testicles, sperm and the body’s ability to produce sperm.
• Radiation and chemotherapy may also damage the endocrine glands in men and women, which can adversely affect fertility.

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Cancer treatment risks for female fertility

A woman should discuss the potential reproductive impacts of her cancer treatment with her oncologist. Certain cancers, particularly those affecting the reproductive organs such as ovarian and uterine cancers, can have a direct impact on fertility regardless of treatment received.

However, in most cases, it is the treatment for the cancer and not the cancer itself that causes infertility. These treatments often damage a woman’s eggs and ovaries, which can lead to premature menopause.

Factors influencing female infertility caused by cancer treatment include:

• Age of patient
• Chemotherapy dosage and type
• Radiation dosage and location
• Location of surgery
• Type of targeted therapy or immunotherapy
• Pre-existing conditions that affect fertility.

Oncologists can help patients fully understand their risk of infertility based on the specific treatment regimen that will be used to treat the cancer. Oftentimes, patients will receive a combination of treatment types (i.e. surgery to remove the tumor followed by a round of chemotherapy).

How cancer treatment impacts female fertility

Different types of cancer treatment affect a woman’s fertility in different ways. As a general rule, the longer the duration of treatment and the greater the dose of treatment drug, the greater the risk to her fertility.

• Chemotherapy drugs can damage a woman’s eggs. Certain chemotherapy drugs cause more damage to the eggs than others. Women are also urged to avoid pregnancy during chemo and for six months after receiving it to reduce the risk of birth defects.
• Radiation treatment uses energized waves to destroy cancer cells. It may also damage healthy cells, including egg follicles on the ovaries. Radiation directed at the pelvic area will most likely cause a woman to become infertile.
• Surgery to remove cancer can cause infertility through the removal of reproductive organs such as the ovaries (oophorectomy) or the uterus (hysterectomy). Surgery can also cause scarring of the fallopian tubes, which can inhibit a woman’s ability to get pregnant.
• Targeted therapy and immunotherapies are new types of cancer treatment currently the subject of many research studies and clinical trials. As such, their impact on fertility is not fully understood. However, certain targeted drugs have been shown to cause ovarian failure and birth defects.

Cancer treatment risks for male fertility

A man should discuss the potential reproductive impacts of his cancer treatment with his oncologist. Cancers of the reproductive system such as testicular cancer may have a direct impact on a man’s ability to produce healthy sperm.

As with women, in most cases, it is the treatment for the cancer and not the cancer itself that causes infertility. The factors influencing male infertility caused by cancer treatment are also the same as for women (see above).

How cancer treatment impacts male fertility

As with women, different treatments affect a man’s fertility in different ways, as does the rule that longer treatments and greater doses bring greater risk to male fertility. Following are how treatments specifically affect male fertility.

• Chemotherapy attacks rapidly dividing cells in the body, which is why it is used to destroy cancer cells. Sperm cells are also rapidly dividing, so chemotherapy can have devastating effects on a man’s sperm. Certain chemotherapy drugs are more likely than others to cause sperm damage. Some men recover their ability to produce healthy sperm a few years after treatment has concluded, and others remain sterile for the rest of their lives.
• Radiation treatment uses energized waves to destroy cancer cells. When targeted at the pelvic area, such as in the treatment of testicular cancer, radiation therapy will often leave a man infertile.
• Surgery on the male reproductive organs such as orchiectomy (removal of a testicles) can directly impact male fertility. However, men can still produce sperm as long as one healthy testicle remains. Nevertheless, The American Cancer Society recommends fertility preservation for men undergoing orchiectomy in case the remaining testicle is abnormal in some way following cancer treatment. Other surgeries for cancer that can cause male infertility include prostatectomy (surgical removal of the prostate), radical cystectomy (surgical removal of the bladder), and certain surgeries known to damage nerves that control a man’s ability to ejaculate.
• Targeted therapy and immunotherapies, new types of treatment being studied, are not fully understood regarding impact on male fertility. However, certain targeted drugs have been shown to cause birth defects. Men undergoing targeted therapy or immunotherapy for cancer should not have unprotected intercourse.