Cancer Treatments and Their Impact on Fertility: A Critical Consideration for Women

As the world continues to advance in medical treatments, the effects of these treatments on various aspects of health, including fertility, have become a significant concern. For women, particularly those undergoing cancer treatments, the impact on fertility can be profound and long-lasting.

Radiation Therapy: A Double-Edged Sword

Radiation therapy, a common treatment for cancer, can have devastating effects on fertility if the radiation is directed at or near the reproductive organs. When radiation is applied to the abdomen or pelvis, it can damage both the uterus and ovaries. The extent of the damage depends on the method of radiation, the total dose, and the patient's age and stage of development.

For the ovaries, high doses of radiation can destroy eggs, leading to infertility and early menopause. This is particularly concerning for older women, as the number of eggs in the ovaries naturally decreases with age. However, a minor surgery to move the ovaries away from the radiation target area can sometimes preserve some eggs and maintain fertility.

Radiation to the uterus can also cause significant issues, including damage to the muscles and blood supply, which can limit uterine growth and expansion during pregnancy. This increases the risk of miscarriage, low-birth weight infants, and premature births, especially in women who received radiation during childhood.

Chemotherapy: A Broad Impact

Chemotherapy, another cornerstone of cancer treatment, targets rapidly dividing cells, including those in the ovaries. This can lead to premature or early menopause, either temporarily or permanently. Certain chemotherapy medications, such as busulfan, carmustine, and cyclophosphamide, are more likely to cause infertility.

The impact of chemotherapy on fertility is influenced by factors such as the patient's age, the type and dose of chemotherapy, and whether the treatment is combined with radiation therapy. Higher doses and multiple chemotherapy agents increase the likelihood of permanent infertility.

Hormone Therapy and Advanced Treatments

Hormone therapy, which alters hormone levels to combat cancer, can also affect fertility. These treatments can make it difficult to conceive or carry a pregnancy to full term and may even cause early menopause.

Targeted therapy and immunotherapy, while less studied in terms of fertility impacts, have shown potential risks. Medications like bevacizumab (Avastin) and certain immunotherapies can interfere with ovarian function and increase the risk of birth defects.

Bone Marrow or Stem Cell Transplant: High-Risk Procedures

Bone marrow or stem cell transplants, which often involve high doses of chemotherapy and sometimes radiation, can permanently stop ovarian function, leading to infertility. This is a critical consideration for women undergoing these procedures.

Evaluating Fertility After Treatment

The return of menstrual periods after cancer treatment does not always guarantee fertility. Women who experience early menopause due to treatment may face permanent infertility. Even if menstrual periods resume, fertility may still be compromised.

Ovarian reserve testing, which includes hormonal tests like the anti-Müllerian hormone test, can help determine the likelihood of pregnancy and the need for fertility assistance.

Seeking Support and Alternatives

For women in Spain and elsewhere facing fertility issues due to cancer treatments, reproductive medicine offers several alternatives. With the increasing demand for fertility treatments, especially at the start of a new year, many are turning to assisted reproduction methods. In Spain, for instance, one in ten children are born through assisted reproduction treatments, highlighting the growing reliance on these technologies.

As the medical community continues to evolve, it is crucial for women to discuss their fertility options and risks with their healthcare providers before, during, and after cancer treatment. This proactive approach can help mitigate the impact of cancer treatments on fertility and provide hope for those seeking to start or expand their families.