Some cancer treatments such as chemotherapy, radiotherapy or surgery have a temporary or permanent impact on fertility. What fertility after cancer? What are the chances of procreation? When do you get your period again?
We’re talking aboutsubfertility when a woman has difficulty procreating and of sterility whenshe can’t be pregnant. Treatments against gynecological cancers alter the functions of the organs, which in some cases will lead to the sterility of the woman. “Cancer treatments can affect fertility in women in different ways. Regarding gynecological cancers, when the treatment consists of removing the diseased organ (ovary, uterus, fallopian tubes) then the woman will no longer be able to procreate naturally“, explains in the preamble Nasrine Callet, gynecologist, contacted by the Journal des Femmes. And the other treatments? The chemotherapy ? The radiotherapy ? What are the chances of procreation after cancer?
The chemotherapy impact temporarily or permanently the reproductive system of women, depending on the dose, duration and nature of the products used. This treatment puts the ovaries to sleep, which then no longer fulfill their functions. “In the context of breast cancer or leukemia in particular, cancer drugs are extremely toxic to the ovaries“, says Dr. Callet. The vast majority of chemotherapy has an impact, more or less significant, on fertility. “Indeed, this treatment acts on cells with rapid renewal – cancer cells therefore. The cells of the ovaries renew themselves just as quickly and are therefore also affected”she adds.
Although the effects of chemotherapy vary from man to man, it can indeed affect long-term male fertility. Just like targeted radiotherapy on the pelvic area in particular and surgery in this same area. The sperm storage before cancer treatments, is a simple and effective method, when the patient is pubescent. In a non-pubertal patient, “a surgical procedure is scheduled to remove a fragment of germinal tissue, which will be brought to the laboratory to be frozen. The reuse of these tissue fragments may be requested by the patient as an adult.explains the Nantes University Hospital on its website.
Still in the context of the treatment of gynecological cancer, “radiotherapy sterilizes the entire pelvisalso called the pelvis (where the uterus, fallopian tubes, ovaries and vagina are located, editor’s note)”notes the specialist.
“The earlier cancer is detected, the less invasive the treatment, the higher the chances of remission and subsequent childbearingexplains Nasrine Callet. It is also to preserve fertility that early detection of cancer is important.“.
The return of menstruation after cancer is, again, on a case-by-case basis. As seen above, during chemotherapy, women do not have their periods because this treatment affects the functioning of the ovaries. “The patient can then return to a regular cycle or not. Natural fertility may return after chemotherapy, especially in young women“, notes our expert. Indeed, the younger the women, the greater their stock of oocytes. While after 35/40 years, the stock of oocytes of a woman decreases significantly. “Return of menstruation and fertility also depends on the psychological impact of the cancer on the patient, the impact of the treatment (duration, dose, nature of the products…) and its age… these reasons explain why the periods may sometimes not return. There is no certainty in this matter.” says the gynecologist.
“It is important to talk about fertility and fertility preservation as soon as cancer is diagnosed, even if it is indeed not a priority for women at the time. In France, you can freeze embryos or oocytes”, emphasizes our interlocutor.
► Oocyte vitrification: With the exception of hormone-dependent breast cancers, this mode of fertility preservation consists of hormonally stimulating the ovaries in order to collect oocytes. The patient can then have recourse to in vitro fertilization once she has recovered. This technique”must therefore be validated by the oncology team due to the hyperestrogenism it induces, as well as treatment delays“, writes the Curie Institute.
► IVF followed by embryo storage: “This involves performing in vitro fertilization and freezing the embryos obtained. These can be transferred after the end of the treatments if the patient wishes to become pregnant. This technique may be indicated for adult patients, in a couple, considering a parental project. Its limits are age and the need for hormonal stimulation”, explains the cancer research center.
“In the context of breast cancer, we don’t stimulate with hormones for fear of activating cancerous cells. However, there are specific products to stimulate the ovaries and collect the oocytes. Chemotherapy then begins immediately after“, further specifies Nasrine Callet.
“It is important that the person is cured or in complete remission to consider pregnancy”
“No, these treatments are too toxic. In fact, a pregnancy is unthinkable during the treatment, summarizes the gynecologist. Chemotherapy has been known to numb the ovaries in most cases, but birth control is still given to women of childbearing age. It is very important not to be pregnant with these treatments because they can be responsible for malformations in the fetus“. In addition, the patient must observe a variable delay after the end of the treatments to consider a pregnancy. “In general, whatever the type of cancer and whatever the type of treatment, it is important that the person is cured or in complete remission to consider pregnancy. Sufficient follow-up must therefore be observed: this will depend on the type of cancer and its severity. Authorization is given during a puridisciplinary skills meeting“, concludes Nasrine Callet.
Thanks to Dr Nasrine Callet, gynecologist at Institut Curie
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