Breast cancer is the most common cancer diagnosed in U.S. women, followed by lung and colorectal cancers.  The fourth leading women's cancer is cancer of the uterus.

Most times, the treatment, not the cancer itself, can cause infertility and premature ovarian failure.  Factors such as age, type of cancer and type of treatment can influence risk.  Cancer treatments such as surgery, radiation and chemotherapy, can affect fertility.  The following information is taken from several sources, but patients must be advised to seek the advice of a medical professional.

• Breast Cancer - Two common components of breast cancer treatment, chemotherapy and tamoxifen, are very effective in decreasing recurrences and improving survival. However, these treatments may also negatively affect a woman's ability to conceive. Chemotherapy, particularly alkylating agents, can quickly and dramatically reduce a woman's supply of eggs causing immediate or eventual premature meno­pause in many women. Even in women who resume regular menstrual periods after treatment, there may be a shortened window of time to achieve pregnancy. If the remaining pool of eggs is already below a critical threshold after cancer therapy, pregnancy using one's own eggs may no longer be possible regardless of whether menstrual cycles are occurring. In contrast, tamoxifen is not known to directly damage the ovaries or affect the egg supply. However, because the duration of treatment is typically five years, many women will experience age-related infertility upon the comple­tion of tamoxifen. Because it is difficult to predict whether a woman will be fertile after cancer treat­ment, for women who would like to have children in the future, it is a good idea to consider fertility preservation options before starting cancer treatment.
• Reference:  How Breast Cancer Affects Your Fertility
• Leukemia - The leukemias most common in the under 45 age group (eg acute lymphoblastic leukemia and acute myeloid leukemia), Hodgkin disease, and non-Hodgkin lymphoma are typically treated with multiagent cyclic chemotherapy, which can cause cessation of menses or premature ovarian failure. Lymphoma may also be treated with radiation therapy to sites of local disease that may encompass the ovaries and uterus, contributing to infertility.

  • Reference:  Preserving Fertility After Cancer

• Cervical Cancer - Women can be treated for their cervical cancer and still maintain fertility. The procedure is called a radical trachelectomy.  In this procedure, the cervix is removed but, unlike radical hysterectomy where the uterus is removed along with the cervix, the uterus is kept intact and it's reattached to the vagina so that women can get pregnant afterwards. The recurrence rate and survival is the same or better than for women undergoing radical hysterectomy.  All women who undergo this procedure require a cerclage placed either at the time of surgery or early in their pregnancy. A cerclage is a suture that's placed in the lower uterus to hold the pregnancy in place. Another important fact is that all women who undergo a radical trachelectomy must deliver by Cesarean section. A number of patients have been able to get pregnant and deliver healthy babies multiple times after undergoing this procedure.  Women should ask their doctors whether they're candidates for this procedure and should seek a consultation with a gynecologic oncologist who's skilled in performing this procedure.
• Reference:  Fertility Preservation in Cervical Cancer
• Ovarian Cancer - surgery typically involves removal of both ovaries as well as the uterus. For young women, this eliminates fertility and results in an abrupt menopause.  Preservation of the non-cancerous ovary may be considered in women with Stage IA or IC ovarian cancer and allows women to preserve their fertility.
• Reference: Wright JD, Shah M, Mathew L et al. Fertility preservation in young women with epithelial ovarian cancer. Cancer [early online publication]. August 10, 2009.
• Endometrial Cancer - The endometrium is the inner lining of the uterus.  When uterine cancer is diagnosed, hormone therapy may be considered, but this therapy does not include evaluation of the extent of the cancer.  The usual treatment is removal/biopsy of the uterus (and sometimes ovaries).  Oocyte and embryo freezing may be considered as Fertility Preservation methods.
• Reference:  Fertility Preservation in Uterine Cancer and Endometrial Hyperplasia

For detailed information on the following Fertility Preservation options, including costs, please view our previous Fertility Preservation 101 issues.

• Embryo Cryopreservation - established Fertility Preservation procedure, and should be the first option considered if the woman has a male partner.
• Oocyte (egg) Cryopreservation - if possible to arrange, this method provides the patient with the combination of the least invasive procedure and most options in the future.  No sperm source is required at the time of freezing.
• Ovarian Suppression - GnRHa (Gonadotropin Releasing Hormone analog) treatment is used to suppress ovaries during chemotherapy, and this treatment is considered experimental.  The success rate is still unknown.
• Ovarian Tissue Cryopreservation - offers the advantages of limited treatment delay, no requirement of a sperm source, no hormonal stimulation required, and ovarian tissue can be retrieved from pre-pubescent girls even as young as a few months old.
• Ovarian Transposition, Radical Trachelectomy and Ovarian Shielding are additional options that should be discussed with a patient's physician.