What is Oncofertility?
Oncofertility is the crossover between cancer care and reproductive health, particularly related to fertility for cancer patients and survivors. Unfortunately, only 47% of oncologists talk to their patients about preserving fertility before they start treatment. If you are interested in having a child after cancer, regardless of your gender, it is critical to talk to your medical team about your fertility options before you start treatment.
Oncofertility is a relatively new field. Due to its newness, cancer teams don’t always bring up fertility options with their patients before starting treatment. Learn how to start the conversation with your medical team below.
How is Cancer Linked to Fertility?
Anyone can experience infertility, whether they have cancer or not. For people with cancer and survivors, though, infertility is caused by a handful of reasons, including:
- Cancer growing directly on reproductive organs
- Removing reproductive organs to eliminate cancer
- Certain treatment approaches
- Physiological or emotional changes, such as decreased sex drive or stress
Cancer treatment is what often causes infertility in patients and survivors.
- Surgery to remove a tumor can also remove parts of your body that are critical to fertility.
- Radiation to the pelvic area or brain can impact your ability to reproduce by harming nearby healthy cells that are needed in reproduction.
- Chemotherapy is used to attack rapidly dividing cells in the body. While this means that cancerous cells that quickly divide are killed, it also harms cells in the ovaries that also naturally divide quickly, negatively impacting fertility.
- Hormone therapy alters your hormones to attack the cancer, but can also change the hormones in your body that are linked to reproduction.
- Targeted therapy and immunotherapy have unknown effects on fertility.
- Bone marrow or stem cell transplants are often paired with high doses of chemo and/or radiation, which can result in infertility.
The impact of cancer treatment on fertility is unique to each person. Whether or not you are still able to reproduce after treatment is dependent on many factors, including your age, treatment type and dose, and hormone levels.
When to Think About Fertility?
If you are interested in exploring your fertility options, it is important to take action before you begin treatment. You’ll need to check with your medical team about your personal cancer, how aggressive it is, and if you have time to preserve your fertility before you must begin cancer treatment. Fertility preservation can take anywhere from 1-15 days, depending on the preservation option you choose.
Your Fertility Preservation Options
If you have decided to pursue fertility preservation, you have options.
Women and People with Uteruses
- Egg or Embryo Banking – Sometimes called egg or embryo freezing, this option removes eggs from your body and either stores them as is (unfertilized) or as embryos (fertilized or already joined with sperm). Egg or embryo banking takes about 10-15 days to complete and is an outpatient surgical procedure
- Ovarian Tissue Banking – Ovarian tissue freezing is an experimental procedure where an entire ovary, or pieces of an ovary, are removed during an outpatient surgery and then frozen to be stored until you are ready to use them.
- Radiation Shielding – While undergoing radiation to treat your cancer, shielding can be used to reduce the radiation exposure to your ovaries, thus reducing the risk of infertility.
- Ovarian Transposition – This outpatient procedure moves your ovaries away from where you will be receiving radiation, in the hopes of preventing radiation exposure to your ovaries
- Radical Trachelectomy – If you have early stage cervical cancer, you can undergo this inpatient surgery to remove your cervix but preserve your uterus.
- Ovarian Suppression – While undergoing chemo to treat your cancer, you can take monthly injections of a medication to block hormones that would normally stimulate your ovaries. This prevents eggs from maturing, which protects them from the chemo.
Men and People with Penises
- Sperm Banking – Sperm banking allows you to store semen that can be used at a later date. Sperm banking is also known as sperm cryopreservation or semen storage.
- Radiation Shielding – While undergoing radiation to treat your cancer, shielding can be used to reduce the radiation exposure to your testes, thus reducing the risk of infertility.
- Testicular Tissue Cryopreservation – If you are a cancer patient that hasn’t yet gone through puberty, or you’re a parent of a child with cancer, you are not yet producing sperm and therefore are unable to preserve a semen sample. This option allows you to store immature sperm or testicular tissue.
Parents of Kids with Cancer
If your child has cancer and is interested in having a biological child later in life, you should consider their fertility preservation options prior to starting cancer treatment. A reproductive specialist can discuss all of your options with you and your child, and help your family make a decision about which procedure is best for them.
If your child is undergoing radiation as part of their treatment, talk to their medical team about radiation shielding. This noninvasive approach can shield their reproductive organs from radiation, hopefully reducing their risk of infertility later in life. Your child’s options for fertility preservation depend on whether or not they’ve already gone through puberty.
Options Before Puberty
- For girls or kids with uteruses – Ovarian tissue banking is your child’s only option at this time. They will undergo surgery to remove an entire ovary, or part of an ovary, to be stored for later use.
- For boys or kids with penises – Testicular tissue cryopreservation is your child’s only option at this time. They will undergo surgery to collect immature sperm or testicular tissue, which will be stored for later use.
Options After Puberty
- For girls or kids with uteruses – Your options are egg banking and ovarian tissue banking.
- For boys or kids with penises – Your child can do sperm banking, either by providing a sperm sample themselves or through surgical extraction or electroejaculation, both of which are done under sedation.
How to Talk About Fertility Preservation
Cancer survival rates have been increasing over the past 30 years. As more adults and children can look forward to life after cancer, they still face the possibility of infertility.
Talking to your medical team about fertility might feel awkward, but it’s important to discuss before you or your loved one starts treatment. Here are a few questions you should ask:
- How will my cancer and treatment affect my fertility?
- What is my risk for infertility?
- Can you refer me to a fertility preservation specialist?
- Do I have time to pursue fertility preservation?
Learn more about talking about fertility with your medical team here.
How expensive is fertility preservation?
The cost of fertility preservation depends on your insurance status, type of procedure you are undergoing, and location. Be sure to ask your medical team if their institution offers funding for fertility preservation for people with cancer, and also ask the fertility clinic if they offer discounted pricing for patients. As of 2022, 15 states – Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia – require insurance plans to either cover or offer coverage for infertility diagnosis and treatment.
Do I have time for fertility preservation?
In order to complete fertility preservation, you will have to delay your treatment. This delay can be anywhere from 1-2 days (sperm banking) to 10-15 days (egg/embryo banking) long. It is your decision about whether or not to delay treatment in order to complete fertility preservation, but your doctor will be able to tell you specific information about your cancer, how aggressive it is, and what a delay in treatment will mean for you.
Do I still have to use contraception to prevent pregnancy if I’m going to be infertile anyways?
Yes! The risk of infertility due to cancer treatment ranges from 20-80% depending on a combination of factors. Because of this, there’s no guarantee that you will or will not lose your fertility after treatment. Your doctor can tell you whether a hormonal or barrier type of contraception is more appropriate for you at this time.
Fertility was never discussed with me prior to treatment. What’re my options now?
Depends on whether or not you lost your fertility due to treatment. If you didn’t lose your ability to reproduce, you can get to baby making whenever you’re ready. If you did become infertile due to treatment and you want to have a child, your options now include using donor sperm or eggs, adoption, and/or surrogacy. No matter what your family looks like, it’s yours.
What hospitals offer fertility preservation for cancer patients?
Search for fertility clinics and centers here.
Where can I get more information or help with my fertility options?
Understanding your fertility options and managing the cost can be daunting. The Fuck Cancer CareLine can help you navigate your options, find a fertility clinic, and access any available funding. Learn more here.
For more information on oncofertility, visit www.letstakecharge.org.
Sources: American Cancer Society; The Oncofertility Consortium