JOIN USSudha (name changed) was diagnosed with stage II breast cancer at a young age of 27. She came to know about her illness soon after she got married and her cancer treatments went on for three long years.
After various tests and consultations with the oncologists, she revived her hope in getting a new life when she learnt that she was free of cancer at 30. When Sudha and her husband tried to start a family, they realised that the cancer treatment had taken a toll on her fertility potential and that her ovarian reserve had depleted.
Cancer is a rising concern in India. For thousands of people who are battling the disease, a strong focus is on life after cancer. Fighting and surviving cancer is itself a victory; however, there is now a growing population of young survivors who face quality-of-life issues, including the prospect of having a child post cancer treatment.
This is when onco-fertility or fertility preservation comes to the rescue. Fertility preservation is an effort to help individuals retain their fertility or ability to conceive.
Cancer may not directly affect fertility of men and women, unless it’s testicular or ovarian. However, the anti-cancer drugs can affect the ovaries, fallopian tubes, uterus or cervix, decrease the number of primordial follicles, interfere with hormonal balance, and eventually reduce the reproductive efficiency of women.
Some women may immediately reach menopause after chemotherapy, resulting in complete cessation of their monthly cycles. Others, whose menstrual cycles resume after cancer treatments, can conceive naturally but only if their ovarian reserve is good both before and after the treatment.
The effect of chemotherapy or radiotherapy in men include compromised sperm count, motility, morphology and DNA integrity. Chemotherapy and radiotherapy work by acting against fast dividing cells of the body. This helps control or stop the cancer cells proliferation, but this treatment can also affect the normal dividing cells of the body and can cause damage to the gametes, that is, eggs and sperms, which are the dividing cells. This can lead to the depletion of gametes, and thereby affect fertility.
Infertility resulting from cancer treatment can lead to great psychosocial stress. Cancer survivors who are free of disease typically view themselves as healthy enough to be good parents, and view their experience of illness as one that can enrich their parental role.
Young men and women in their reproductive years diagnosed with cancer should be prescribed with techniques such as egg, sperm or embryo freezing. Women can preserve their oocytes (women who do not have a partner), freeze their embryos (married women) or even opt for ovarian tissue cryopreservation once they are diagnosed with cancer.
Alternative methods
Post the cancer treatment, if natural pregnancy does not happen, they can conceive through IVF/ICSI. Through preserving one’s fertility by freezing eggs, sperms or embryos, cancer survivors can conceive and carry pregnancy just like any other woman after the disease is completely cured.
It is advised that women who undergo cancer treatment should not plan for pregnancy for at least two years after complete cure. If the woman is of an older age or if she is not having regular menstrual cycles, it is advised to consult a fertility specialist for an initial assessment to evaluate the condition of the ovaries and to understand the probability of achieving pregnancy.
Not every cancer patient will have the opportunity to preserve their fertility before chemotherapy or radiation treatment. Since oncologists are generally the first of doctors whom patients visit to get a screening done, it is important to spread awareness among them initially. They should inform their patients about fertility preservation, especially if they are young men and women who intend to start a family later.
There are many instances where it becomes too late for a cancer patient to take the decision of preserving the gametes or embryos. For those not fortunate to have frozen sperms, eggs or embryos prior to cancer treatment and whose gametes have been completely depleted, IVF with donor eggs or donor sperms is a common solution.
Egg donation is often a successful treatment for infertility in women who can no longer produce healthy eggs. However, nothing can replace the joy of having a healthy child with one’s own eggs/sperms. We have to make sure that every man and woman lives the life after cancer with their own child to cherish every moment of their life.
(The writer is Fertility Consultant, Nova IVI Fertility, Bengaluru)