Planning for a family Some cancer treatments can make it much harder for you and your partner to get pregnant naturally. Putting back-up plans in place now, means you’ll have more options available down the track.
What happens for women? In women, being fertile means being able to produce and release eggs and being able to support a fertilised embryo in the lining of the uterus. During treatment, your body’s ability to do those things can be affected temporarily or permanently.
Reproductive damage If your treatment involves surgery or radiotherapy around your reproductive organs, your fertility may be affected. If the radiation is going directly to the uterus or the ovaries, then you could be looking at permanent infertility. See if you can store eggs before treatment begins.
Chemotherapy choices Some chemotherapy drugs will stop your body producing and releasing healthy eggs. If you’re young and your body recovers from the effects of the drugs, you’ll still have many fertile years ahead of you. But if you’re older and your egg production is already declining, this may have a big impact on your ability to have children. Your options include harvesting eggs and using a different drug which is less likely to cause fertility problems.
Radiation and hormones Your pituitary gland influences the way hormones work in your body and so has an influence on your egg production. For that reason, radiotherapy to the base of the brain where the pituitary gland sits can affect your fertility.
Hormone therapy The hormone therapy used to treat some breast cancers may reduce your ability to release eggs. Things may return to normal once the treatment stops, but hormone therapy may go on for several years. This can have a significant impact for older women whose fertility is in decline.
What happens for men? In men, fertility means being able to produce sperm that will fertilise a woman’s egg. Certain things can happen during cancer treatment that makes this harder or impossible.
Testicular surgery In almost all cases, when you have one testicle removed the other testicle compensates by producing more testosterone and sperm. As a result, your fertility is unlikely to be affected. But if both testes are removed in what they call a bilateral orchidectomy, you’ll no longer produce sperm. Speak to your care team about your options for storing sperm before the operation.
Chemotherapy complications Some chemotherapy drugs can stop sperm production. Sometimes the effect is short-term, sometimes it lasts for years and sometimes it’s permanent. Speak to your care team to find out about the drugs you’re using and what effect they will have on your fertility.
Hormonal upheaval Reducing testosterone levels is an effective way of slowing or stopping some cancers. Sometimes this involves removing the testes, sometimes it involves taking hormone-reducing drugs. Testosterone influences your sex drive, your ability to get an erection and your sperm production. Without testosterone, your body may produce less sperm or none at all and you may have difficulties with ejaculations. Speak to your care team if you want to know more about storing sperm before treatment.
Nerve damage Surgery to the pelvic area or the spine can cause damage to nerves and blood vessels. In some cases, the damage can affect your ability to get an erection or to ejaculate normally. Both of these can affect your ability to conceive naturally.
Radiation Radiotherapy in the pelvic area can cause the testicles to produce less testosterone which in turn affects your sperm production and your ability to get an erection. The effect could be short-term or permanent. Radiotherapy to the base of the brain, near the pituitary gland, can also affect hormone production. To find out more about your situation, speak to your care team.
Harvesting eggs Egg collection usually takes several weeks. As a first step, you’re injected with hormones that stimulate your ovaries to produce more eggs than usual. These eggs are collected by passing an ultrasound-guided needle through the walls of your vagina into the ovary. You’ll be given a sedative or a local anaesthetic for this procedure.
If you’re having hormonal therapy for breast cancer, you’ll be advised against taking egg-stimulating hormones as they may make your cancer grow. In that case, you and your fertility specialist can look at removing just one or two eggs.
Collected eggs can be frozen and stored for artificial fertilisation at a later date. This treatment is still relatively new and is not yet as successful as the well-established procedure of freezing and storing embryos from in-vitro fertilisation (IVF).
Collecting sperm Sperm banking has been around for years. The first step is to visit an andrology clinic (sperm bank) and produce a few sperm samples. If you’re uncomfortable with this, you may be able to produce samples at home but you’ll have to get them to the clinic within 45 minutes. The samples are then frozen and stored for future use. Sperm can also be collected by extracting testicular tissue or fluid under a local or general anaesthetic. This tissue or fluid then goes to a laboratory and the sperm is removed and stored.
Testosterone replacement therapy If a man is unable to maintain an erection he may be unable to have penetrative sex. Testosterone replacement therapy can improve your ability to get an erection. Testosterone can be delivered as a gel, an implant, a patch or an injection and the treatment may go on for years.
Making an embryo IVF is the process of putting eggs and sperm together in a test-tube to let fertilisation occur artificially. When sperm successfully fertilises an egg, an embryo is made. Under normal conditions this embryo would be used straight away, but if you’re having treatment for cancer it can be frozen for future use. At that time, the embryo will be thawed and placed in your uterus in the hope that it will implant.
Conceiving with donated sperm or eggs If you or your partner have fertility issues and you haven’t stored eggs or sperm, you may want to consider using donated eggs or sperm. The idea of using donated sperm or eggs can be confronting; ask your care team to put you in touch with a counsellor if you would like one.
Surrogacy If your uterus has been removed or damaged as part of your cancer treatment, you’ll be physically unable to carry a child. One option is to implant an IVF embryo in the uterus of a surrogate mother. The surrogate mother will carry the baby through pregnancy and then hand over the baby to the biological parent or parents after birth. Surrogacy is legal, however it is a complicated arrangement. In Australia, surrogacy arrangements must be altruistic which means that the surrogate mother receives no payment for her service.
Adoption If you can’t conceive or carry biological children, you might want to adopt. Very few Australian children are available for adoption so it’s more likely that you’ll adopt a child from overseas. The rewards may be great, but be aware that this can be a long and costly process.
Words to know
Andrology the study of diseases specific to male reproductive organs
Cryostorage the process of preserving eggs, embryos or sperm by storing them at temperatures below zero
Embryo a fertilised egg
Hysterectomy surgical removal of the uterus
IVF in-vitro fertilisation is artificial fertilisation of an egg in a laboratory setting
Orchidectomy surgical removal of a testicle
Pituitary gland a gland that controls the production of hormones
Surrogacy an arrangement where a woman carries a baby through pregnancy for someone else
Vitrification a new technique for preserving eggs which involves ultra-rapid cooling of the samples
Questions to ask
Do I have to do anything? If your treatment is going to make you infertile, then harvesting and storing your eggs or sperm now is the only way you can have biological children in the future. It gives you the option to pursue fertility treatments at a later date.
Do I have to use contraception during cancer treatment? Yes. Getting pregnant while either partner is having chemo or radiotherapy can affect the baby.
When can we get pregnant? In general, it’s a good idea to wait at least a year after cancer treatment has finished, to be confident your cancer hasn’t returned. Pregnancy limits what treatments can be used against a cancer.
Expert's insight: Dr Gabrielle Dezarnaulds Dr Gabrielle Dezarnaulds, a fertility specialist at Sydney’s Royal Prince Alfred Hospital, says fertility technology is constantly improving.
“Chemotherapy, radiotherapy and surgery may all pose a risk to fertility. The most important thing for both men and women – if they’re of child-bearing age and they’re not certain they’ve completed their family – is to have a discussion with their cancer specialist.
“The patient should be given an indication of whether their fertility is at risk and, if so, be directed to a specialist to explore the various options of fertility preservation.
“For women, fertility preservation options will be individualised and depend on factors such as the likelihood of fertility problems and how much time she has before treatment starts. For example, it takes at least a couple of weeks to mature and freeze eggs – or embryos if preferred.
“Additionally, a woman may be told not to conceive for a number of years following treatment. So even if the treatment itself isn’t toxic to ovaries, the time delay between diagnosis and the all-clear for pregnancy may be over that critical time of natural fertility decline. We try and give women realistic odds and encourage them to return after cancer treatment to discuss their situation.
“Male fertility preservation is usually much simpler – generally cryostorage of semen is recommended. This can be arranged quickly with any andrology laboratory.”
Expert's insight: Annabel Pollard As head of the psycho-oncology department at the Peter MacCallum Cancer Centre, clinical psychologist Annabel Pollard helps patients come to terms with the emotional consequences of their illness, including facing infertility.
“Cancer treatment may result in substantial losses, for want of a better word, and it’s only natural to grieve over those losses. Some of these losses are bigger than others, and some of them are permanent. They’re the icky things that people often don’t talk about.
“It all depends on your circumstances. If you’re a 25-year-old woman diagnosed with breast cancer, and you’ve had a life-long ambition to be a mother, your situation is completely different from someone without that aspiration. The meaning of a temporary or permanent loss in a person’s fertility will depend on that individual and their age.
“Any type of cancer treatment that affects your functioning is going to affect your relationships. Whether that’s a cancer of the mouth which affects your capacity to engage in something intimate like kissing, or cancer of the bladder which could affect your sexual response.
“Some people might see adoption as a viable option while others might see it as an unacceptable outcome. Examine your priorities. It might be confronting, but if you’re not alive, you can’t have children.
“From a psychological perspective, the bigger issue is how to cope with a significant change in function. This could generate a number of different responses.
“What is really important and meaningful to you? Prioritise what’s most valuable, but that doesn’t negate the fact that you might be left with significant impairments which you may have to live with for the rest of your life. That’s not to say that you can’t do creative things to adjust to, or manage, those changes.”
More help The Fertility Society of Australia (FSA) www.fertilitysociety.com.au The FSA is the peak body representing all the health professionals working in reproductive medicine. Go to their website and click on Patients information for contact details for relevant services in every state and territory.
Adoption www.adoptionawarenessweek.com.au The website for National Adoption Awareness Week has lots of information about local and international adoption plus links to the relevant government agencies in every state and territory.
Andrology Australia 1300 303 878 www.andrologyaustralia.org For information on male reproductive health.
Photo by Nick Cubbin
CLAIRE WILKINSON Claire Wilkinson was 29 and single when a routine Pap smear found cervical cancer. She’d always dreamt of having kids, so her first question was about how it would affect her fertility. After a hysterectomy, she had her eggs frozen using a new procedure called vitrification. She then had chemo and radiotherapy for her cancer. Despite being diagnosed with thyroid cancer shortly after her treatment for cervical cancer finished, she has been cancer-free for two years.
Together with her new partner, she is now looking forward to fertilising the eggs and having a baby via a surrogate soon.
“I always wanted the big family, the big house with the pond in the front garden and four kids. When I had the hysterectomy, they discovered cancer had spread to my lymph glands. They gave me a three-week window before starting chemotherapy and radiotherapy. They said, ‘If you want to start IVF, you need to start today.’
“I’d just had abdominal surgery so I injected the hormones into my hips every day. I was also on blood thinning injections. I felt quite horrendous.
“After two weeks, they harvested the eggs from my ovaries and I got seven precious eggs. Thankfully, due to my age, the eggs were ‘top grade’, and as the Beijing Olympics were on at the time I considered these to be my gold medals.
“I do consider myself to be lucky – firstly that I had the option of IVF, secondly that it worked. At the time the success rate of falling pregnant with a vitrified egg was only low. But now it’s over 40 per cent.
“It was expensive, $10,000 up-front, but I’d do it all over again. I’d recommend that anyone put fertility at the top of their treatment choices – to delay treatment as much as the doctors will let you to go through IVF. It’s definitely worth it. It’s great to have that option for the future.”
Photo by Bruce Daly
JONATHON ESTE When Jonathan Este was diagnosed with bowel cancer last year, it kicked off a roller-coaster ride. He and his wife, Max, had been keen to start a family but, suddenly, making a baby would involve sperm banks and IVF.
“When I was coming out of sedation after my colonoscopy, I was asked ‘Do you want to call your wife?’ They’d found a large tumour right down in the rectum and several polyps.
“I was umming and ahhing about chemo and radiotherapy. At first the surgeon said he wasn’t sure it would make much difference to my cancer. He also told me radiotherapy would affect my fertility. Then some new studies came out that showed tumours like mine actually responded really well to radiotherapy. That made up my mind.
“As to fertility issues… The people at Prince of Wales hospital [in Sydney] referred me to a sperm bank. I made a ‘deposit’ but they couldn’t find any sperm in the samples.
“I was then referred to the urologist. There’s something in the words ‘we’re doing a biopsy of your testes’ that really focuses your mind. It turned out I had ‘lazy’ sperm. Probably the result of decades of drinking and smoking!
“At the biopsy they took 13 straws of semen and there were heaps of swimmers. It was terrific to get some good news. It was a real ‘woo-hoo’ moment.
“Max is now 38 and I’m pushing 50. We’ve got to do babies really soon. The cancer put everything back a year. But if I hadn’t been diagnosed and gone to the sperm bank, it would have been a problem later on. We would have been wasting time with me shooting blanks with my lazy sperm.
“We delayed cancer treatment until we dealt with the fertility issues. Looking at doing IVF was just something we had to do. It became whatever it takes. Max was totally supportive.
“We’ve talked about doing IVF, what it will entail and what stresses it will bring. That’s our big decision for this year. But as medical issues go, it certainly beats having cancer.”