Future fertility and the opportunity to have a family are among the most important concerns of people with cancer. Dr Violet Kieu, Fertility Specialist from the Reproductive Services Unit at The Royal Women’s Hospital and Clinical Senior Lecturer at The University of Melbourne speaks to Pink Hope about in-vitro fertilisation (IVF).
Breast cancer, ovarian cancer and cancer treatment can impact a woman’s fertility or the ability for survivors to conceive and reproduce. However, if you hope to have children, there are options available to you to explore. One such option is in vitro fertilisation (IVF).
Cancer treatment, chemotherapy and radiation therapy are the most commonly prescribed forms of treatment for breast and ovarian cancer. These treatments can have a significant impact on fertility and affect your number of viable eggs. Some treatments can damage the reproductive organs and disrupt the hormonal balance necessary for reproduction. There are some specific cancer treatments which may lead to permanent infertility, while in others, it may be temporary.
The effects of chemotherapy on fertility is varied, as it depends on the drug, the dose, the time and of course, the age of the woman who is having the treatment. This is because certain cancer treatments can induce DNA damage of the primordial egg and also to the surrounding support cells, which line the follicles and give the nutrient to the eggs so that they can develop and grow. It’s best to discuss your particular cancer treatment and it’s possible impact on your fertility with your oncology team.
If you are considering cancer treatment and are concerned about your fertility, it is important to talk to your doctor about your options. There are ways to preserve your fertility before treatment begins, such as freezing eggs or sperm, or even embryos if a partner is involved.
Women are born with all the eggs they're ever going to have. Chemotherapy can reduce this follicle pool, which means after treatment you may not have a period or you may have infrequent or irregular periods. We know that at all ages, a woman who has had cancer therapy or chemotherapy is less likely to have a pregnancy than a woman of the same age who has not had cancer treatment. Research shows that women who have had breast cancer treatment have a 40% reduced fertility rate than the general population.
IVF prior to cancer treatment
More people are surviving cancer, thanks to improvements in cancer treatments, but few know that cancer, and cancer treatments, can affect a person’s fertility (or their ability to have children). Several safe and effective onco-fertility options are now open to cancer patients, but, often, a small window exists, just before starting cancer treatment, when a patient needs timely information to make informed decisions about preserving their fertility.
Once a diagnosis of cancer is made, discussion and decisions around fertility can be urgent and time critical. This is to allow time for referral to an onco-fertility unit or fertility clinic so you can have appropriate counselling and informed decision-making to occur.
It takes time to plan and perform fertility preservation (for example, eggs may take around 14 days to grow and collect for freezing) so promptness is important to prevent delays in cancer treatment.
For those who are about to embark on their cancer treatment journey, IVF can take place prior to treatment. Over the course of two weeks, ovaries will be stimulated through drugs before egg collection is made during surgery.
However, if there are any other things such as familial cancer and where imaging suggests an issue with the ovaries, then your team will discuss the safety aspect of the procedure and IVF drugs. Read more about different treatments here.
IVF post-cancer treatment
For cancer survivors who have completed treatment but are struggling with infertility, IVF may be an option. IVF is a procedure where eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. The resulting embryos are then transferred to the uterus, where they can implant and grow into a pregnancy.
IVF can be a safe and effective option for cancer survivors who have completed treatment and are now in remission. However, it is important to discuss the potential risks and benefits of IVF with your doctor before proceeding.
What is onco-fertility?
Onco-fertility is a relatively new medical field that provides options for fertility preservation. Advances in this area include assisted reproductive technology, such as vitrification (fast freezing), means we can preserve eggs, embryos, ovarian tissue, sperm and testicular tissue for future use. This is known as medical fertility preservation. Fertility preservation is about reproductive planning.
Fertility preservation may be someone’s best chance for biological children in the future. We know that pregnancy rates after freezing eggs are similar to those after freezing embryos, with live birth rates of 46% and 54% respectively. Ovarian tissue freezing and grafting for females is no longer ‘experimental’, in particular for women aged 20-plus years.
Cancer treatment can impact fertility, but for those who still wish to have children, IVF may be a viable option. It is important to discuss your fertility preservation options with your doctor before cancer treatment begins, and to discuss the potential risks and benefits of IVF if you are a cancer survivor. It is important to work closely with your doctor to determine the best course of action for your individual needs and circumstances.
