Infertility can be a large problem for young adults and children with cancer. The Canadian Cancer Society states that “for adolescent and young adult women diagnosed with cancer, the loss of fertility resulting from treatment can be especially challenging. Infertility in cancer survivors can be a major cause of distress and can have long-term consequences for their well-being.” This assertion is particularly worrisome since the survival rate for childhood cancers is on the rise, at 83%. This means that the fertility of thousands of young adults is at risk. In Canada, as of 2018, there are no clear guidelines on how to preserve fertility in young people undergoing cancer treatment. The Canadian Cancer Society commissioned a study to develop a uniquely Canadian tool which involves conducting research to evaluate Canadian women’s experiences in terms of fertility and then to create a pilot project to evaluate this problem with survivors and healthcare professionals. “The project will create a tool that will help young cancer patients and their doctors discuss a complex topic and help them make the best decisions.”
Factors that affect fertility in cancer survivors include chemotherapy, radiation and surgery. Certain types of chemotherapy may alter the way that the ovaries produce eggs in women and the way the testicles produce sperm in men. DNA-damaging alkylating drugs can affect fertility by damaging the mother cells that produce sperm or eggs or by damaging the eggs and sperm cells directly.
Menopause might start when the ovaries are damaged, and it is very difficult to reverse. The younger the woman, the more likely it will be to reverse, with the woman continuing to ovulate after treatment ends. Radiation to the pelvis or reproductive organs can also have a negative effect on fertility. In men, it can cause erectile dysfunction and in women it can damage the ovaries. Surgery of the sexual organs, including the uterus or womb, the ovaries or the testicles, can cause permanent infertility. That is why it is important to talk to your doctor about options for preserving fertility before undergoing treatment.
It is possible to remove eggs from the ovaries and freeze them until you decide to have a child. Sperm can also be collected and frozen before treatment starts until is needed to initiate a pregnancy. (For more information, see the Pregnancy after cancer section.)