Receiving a cancer diagnosis creates an immediate whirlwind of decisions. For many patients, the primary concern becomes surviving and beating the disease. Unfortunately, amidst the urgency of starting treatment quickly, an often-overlooked but critical conversation is missed: fertility preservation before chemotherapy.
Discussions about fertility shouldn’t be an afterthought. While a timeline of weeks or months may seem insignificant compared to the pressing nature of cancer treatment, it can have life-long repercussions, especially when it comes to the ability to have biological children. This blog breaks down why fertility preservation needs to be addressed early, how cancer treatments pose risks to reproductive health, and what options are available for patients.
The Harsh Reality: How Cancer Treatments Impact Fertility
Cancer treatments like chemotherapy, radiation, surgery, and hormone therapies bring hope for remission, but they can also jeopardize fertility. Understanding this impact is the first step to making informed decisions.
Chemotherapy
Chemotherapy targets rapidly dividing cells to destroy cancer. Unfortunately, it cannot differentiate between healthy and cancerous cells, impacting reproductive cells in the ovaries or testes. Chemotherapy may have the following impact on fertility:
- Women may experience premature ovarian failure, decreased egg quality, or complete infertility.
- Men may face reduced sperm count, lower sperm quality, or azoospermia (absence of sperm).
- The extent of damage depends on drug type, dosage, and age.
Radiation Therapy
Radiation is another cancer treatment that could impact fertility. Radiation damages any cells exposed to it, including reproductive organs in or near the treatment area. It could cause issues for fertility, including:
- Pelvic or abdominal radiation can directly damage ovaries, testes, or the uterus, affecting fertility.
- Cranial radiation may disrupt hormone-producing glands that regulate reproduction, impacting ovulation or sperm production.
Surgery
Certain surgeries, such as oophorectomy (ovary removal), hysterectomy (uterus removal), or orchiectomy (testicle removal), result in immediate infertility. These are often necessary treatments for cancers affecting reproductive organs.
Hormone Therapy
Hormone therapy is frequently used for hormone-sensitive cancers like breast or prostate cancer. It could have the following impact on patients:
- Temporary suppression of ovarian or testicular function, delaying the possibility of conception.
- Prolonged treatments may make fertility attempts more challenging later.
The Critical Window: Why “Before Treatment” Is Non-Negotiable
One of the most important messages to understand is that fertility preservation must happen before cancer treatment begins. Here’s why:
Irreversible Damage
Once treatments like chemotherapy or radiation start, reproductive cells and tissues can suffer irreversible harm. Fertility preservation efforts after treatment often prove less effective or outright impossible.
The Loss of Opportunity
For women, fertility preservation requiring ovarian stimulation (for egg or embryo freezing) takes time, usually 2–3 weeks. This timeline may be unfeasible if cancer treatment begins immediately. For men, on the other hand, sperm banking is a quicker process, but if chemotherapy reduces sperm count to zero, retrieving viable sperm becomes impossible.
Maximizing Chances
Eggs, embryos, sperm, or reproductive tissue collected before treatment are of the highest quality, offering the best chance of future conception. Waiting too long can lead to emotional regret and missed opportunities.
Debunking Myths
Many patients worry that they can’t start fertility preservation. However, most patients qualify for procedures, even if they’re unwell. Often, fertility treatments can be performed with minimal or no delay to cancer therapy. Oncologists and fertility specialists coordinate closely to plan overlapping timelines.
Your Options: An Overview of Fertility Preservation Methods
Every patient is unique, and fertility preservation options vary based on age, gender, type of cancer, and treatment urgency. Here’s a breakdown of available methods and why you should consult a fertility specialist before cancer treatment:
For Women
- Egg Freezing (Oocyte Cryopreservation) is best for women without a partner at the time or women who want to preserve their fertility without creating embryos immediately. It involves ovarian stimulation using hormone injections, followed by the retrieval of mature eggs under mild sedation and freezing through a process called vitrification.
- Embryo Freezing is ideal for women with a stable partner or those with higher success rates for future pregnancies compared to egg freezing. It is similar to egg freezing, but the eggs are fertilized using sperm (partner’s or donor’s) before freezing.
- Ovarian Tissue Cryopreservation (OTC) is a game changer for girls who have not yet reached puberty or patients needing immediate cancer treatment. The process involves laparoscopic surgery to remove and freeze ovarian tissue for potential future use.
- Ovarian Transposition: This is a surgical procedure that repositions ovaries away from a radiation field to protect them.
For Men
- Sperm Banking (Sperm Cryopreservation) is ideal for post-pubertal males with normal sperm production. It’s quick, widely available, and effective. During the procedure, semen samples are collected and frozen.
- Testicular Sperm Extraction (TESE or MicroTESE) is used for prepubertal boys (experimental approaches include testicular tissue freezing) and in cases with no sperm in semen due to cancer or other conditions. The process involves surgery to retrieve the sperm directly from the testicular tissue.
The Power of a Multidisciplinary Approach
Successful fertility preservation requires close collaboration between oncologists and fertility specialists. Each brings unique expertise to the table.
Oncologists focus on life-saving cancer treatments and determine how quickly therapy must start, while fertility specialists evaluate the patient’s reproductive health and decide the best preservation options.
Together, they:
- Identify the safest and most efficient timeframe for preservation.
- Select the ideal preservation method suited to the patient’s individual needs.
- Ensure minimal or no delay to cancer treatment.
Patients must feel empowered to ask about fertility preservation. Oncologists might focus on immediate treatment, so raising this topic can be lifesaving before irreversible damage occurs. If you or a loved one has received a cancer diagnosis, consulting with a fertility specialist can open a world of possibilities.
Securing a Future with Fertility Preservation at ONE Fertility Kitchener Waterloo
Fertility preservation is not only a medical option but a message of hope for cancer patients. If you or someone you know is navigating cancer treatment, don’t wait.
At ONE Fertility Kitchener Waterloo, we offer personal consultations, counselling, and fertility plans for men and women undergoing cancer treatments. Our comprehensive fertility care plans are based on clinical and scientific research and have helped thousands of people realize their parenthood dreams. Contact us today to schedule a personalized consultation with one of our fertility specialists.
