Cancer and Infertility
Suffering from cancer without having fulfilled the desire to have a child brings an emotional difficulty additionally to facing a threat against our own life. In principle, a cancer diagnosis causes great fear of death.
However the current likelihood of early detection and a wide range of treatment available have dramatically increased the chance of surviving this disease. Once the fear of losing life is over, there are new anguishes that become significantly important and that must be addressed. Among the most significant is the desire to raise a family.
Both cancer and the treatments required, can affect men and women’s fertile potential. Cancer of the ovary and testis can affect the function of these organs, producers of ova and sperm respectively, required for the genesis of pregnancy. The uterus may also be affected directly by cancer and/or its treatment. They often require surgery that involves the removal of these organs, thus affecting fertility. In addition, chemotherapy and radiation therapy to the pelvic area may destroy the reserve of ova in the ovaries, drastically reducing the ability of the uterus to carry pregnancy to term and definitely affect the potential for sperm production of the testicle. This phenomenon tends to be definitive with the use of radiation therapy and sometimes temporary if the patient has chemotherapy treatment. Finally, sometimes it requires hormonal treatment that may also affect men and women’s fertile potential.
Fortunately science has also evolved in this aspect. In the search for alternatives for these men and women, cancer victims, strategies have been developed that can preserve their reproductive potential, despite having to undergo aggressive treatment that would derail the possibility of being parents. Today women can access the freezing or cryopreservation of eggs before their ovaries removal or the use of chemotherapy or pelvic radiotherapy. These ova may be thawed and used to form embryos in the laboratory, which are then transferred to the woman’s uterus, previously treated and cured of her cancer diagnosis. In this way she will be able to achieve pregnancy with her own eggs, despite no longer having functioning ovaries in her body.
If there is not enough time to stimulate the ovaries, remove the ova and cryo-preserve them or if urgent surgery is required, a woman has now the option of the ovarian tissue cryopreservation. This may be thawed and transplanted to her pelvis, thus allowing the recovery, at least temporarily, of her ovulation function and fertile potential. In this way a spontaneous pregnancy may even occur.
There are also some therapeutic alternatives for women, using some medicines, which lead the ovaries to a resting state during the entire oncologic treatment. This seems to be a useful strategy in the preservation and restoration of the spontaneous female reproductive function, after chemotherapy treatment has been completed.
Women who have to undergo surgical removal of the uterus, but their ovaries are preserved, a therapy known as surrogate uterus has been developed. It involves the removal of the eggs from the woman’s ovary, to take them to the in vitro fertilization laboratory; there they join the spouse’s sperm, allowing the formation of embryos that are then transferred to the uterus of another woman to carry pregnancy for 9 months.
Finally, if eggs or the ovarian tissue cannot be preserved, pregnancy may be sought through in vitro fertilization with donated eggs. These eggs are obtained from young women, extremely healthy and with physical features similar to those who will receive the donation. They are carried to the in vitro fertilization laboratory to be fertilized with the spouse’s sperm and then are transferred to the mother’s previously prepared uterus.
As for men, preservation of fertility has an extremely easy, effective and saving strategy. It is the cryopreservation or freezing of semen in liquid nitrogen at minus 196 degrees Celsius below zero.
As it may be seen, there are several strategies to bring a light of hope to the people who are now facing the tragedy of cancer and that still want to fulfill their dream of becoming parents.
Dr. Juan Luis Giraldo