Chemotherapy and Fertility: Effects and Defenses

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Key Takeaways:

  • Some chemotherapy and radiotherapy treatments have negative lasting effects on fertility

  • Fertility in both women and men is affected by cancer treatments

  • Men can easily protect themselves by depositing their most valuable assets today

While the general prevalence of cancer has increased in recent years, so, too, has the overall outcome of long-term survival, thanks in no small part to chemo- and radiotherapy treatments.

At the same time, though, both men and women face potential threats to fertility as a result of undergoing chemotherapy treatments for cancer.

Knowing the potential threats goes beyond the kind of common-sense realization, experienced by anyone who has sat for a dental x-ray while wearing a protective barrier, that the introduction of chemicals or radiation could also pose side effects to vulnerable organs. The possible impacts of treatment could also extend to systems and areas of the body that one rarely, if ever, thinks about, but which could nonetheless affect fertility.

Thinking beyond the lead vest

For example, a 2011 study published in the journal Obstetrical & Gynecological Survey took a closer look at the effects of chemo- and radiotherapy on fertility in premenopausal women – precisely because physicians needed to be aware of which methods to use, whether “high-risk” or “low-risk”, to assess potential risks to fertility before beginning treatment.

Some of the more specific issues at hand were examined in a 2012 study published in the journal Best Practice & Research Clinical Obstetrics & Gynaecology, which describes a variety of effects of chemotherapeutic agents on young women: Cells growing in areas with high turnover, such as bone marrow and ovarian follicles, become vulnerable to the toxic powers of alkylating materials, which are the most common type used in chemotherapy medications. If ovarian follicles are lost, ovarian blood-vessel damage could result, possibly leading to premature ovarian failure.

The American Cancer Society (ACS) minces no words when advising women: Any “body system malfunction” at any stage of a woman’s life could result in changes to fertility. The organization advises women to speak with their health care team about fertility before beginning any treatment, noting, “There might be ways to save or protect your fertility before and maybe even during treatment. But after treatment, options are often more limited.”

The ACS lists a host of specific drugs which are most likely to affect fertility as well as those that are believed to pose a low risk of damaging eggs. Again, women are urged to speak with their physicians about which chemo drugs they are likely to receive and the specific risks that accompany them. Women must also consider factors such as age and avoiding getting pregnant during chemo (some women remain fertile throughout portions of their treatments).

Protecting beyond the obvious

The National Cancer Institute (NCI) presents a similarly straightforward overview of the effects of chemotherapy on male fertility. As is the case with women, chemotherapy treatments can affect a man at any age, including during his youth. Importantly, the NCI notes, “[N]ot all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation”.

To help men take a more proactive stance with their physicians – particularly to address the issue of possible transmission of cancer-treating chemicals between partners during sexual activity -- the NCI lists several recommended questions, including the following:

·       Based on the treatments I’m expected to receive, do you recommend condom use?

·       Do you also recommend additional birth control methods?

·       Which fertility preservation options are available at this hospital? Which are available at a fertility clinic?

·       What are the odds that my fertility will return to normal once I am finished with treatment?

·       Would you recommend that I have a conversation with a fertility specialist so that I can learn more about my options?

The NCI also outlines other treatments which men need to take into consideration when attempting to preserve their fertility. These include stem cell procedures such as peripheral blood stem cell transplants and bone marrow operations, which can damage sperm as well as cells that form sperm; hormone therapy, which can reduce the production of sperm; and, surgery for pelvic cancers such as prostate, rectal, and bladder cancer, which can result in organ damage as well as to nerves and lymph nodes located in close proximity to the area(s) of surgery, resulting in a state of infertility.

An ounce of prevention

For both men and women, the proactive approach provides the best possible protection against not only the obvious impacts to fertility, but myriad unknowns. Storing your assets before undertaking any form of therapeutic medical treatment is precisely in line with this approach.