Cancer treatment affects fertility in women: doctors tell

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Cancer treatments are important for improving quality of life after cancer, but they can affect reproductive organs and glands related to fertility. A woman can become infertile and changes in her fertility can be temporary or permanent. One will have to talk to the fertility consultant before undergoing cancer treatment and go for egg freezing which can help her to get pregnant in the future and fulfill her dream of motherhood. Cancer strikes when cells divide and multiply much faster than most normal cells. Chemotherapy, radiation therapy and surgery can have many side effects and tend to increase or cause infertility. Infertility is the inability to achieve pregnancy. Cancer treatment can damage the ovaries, fallopian tubes, uterus and cervix which are involved in reproduction.

Dr Prashant Mullerpatan MS, FRCS Consultant Oncosurgeon, Apollo Spectra Hospital, Mumbai, said: “A woman diagnosed with cancer will need to undergo chemotherapy, radiotherapy, hormone therapy, surgery or transplant. Her attending physician will decide the line of treatment for her. But a woman should dispel all her doubts about the potential side effects of the treatment because one can even become sterile. Chemotherapy impacts the ovaries, and they may stop releasing eggs or estrogen and this may be known as primary ovarian failure (POI). This condition will be short-lived and menstruation will regularize and fertility can be restored after treatment. But, in many cases, the damage to the ovaries is irreversible and there will be permanent infertility. So, a woman has symptoms such as hot flashes, night sweats, irritability, vaginal dryness, and irregular or no periods. Healthy eggs can be depleted in the ovaries due to chemotherapy.

Dr. Richa Jagtap, Clinical Director and Consultant in Reproductive Medicine, NOVA IVF Fertility, Mumbai, said: “A woman’s fertility depends on the proper functioning of her reproductive organs. If a woman is unable to conceive for about 12 months after regular sexual activity, she is considered infertile, and after 6 months, if the woman is over 35. Chemotherapy, radiation therapy or surgery damage the ovaries which store eggs and the ovary. the reserve decreases. Women are born with an infinite number of eggs, but when the eggs are lost they cannot be replaced and there can be infertility and premature menopause. Becoming pregnant after cancer treatment is a challenge. Chemotherapy and radiation therapy specifically work to deplete growing cells in the body. Unfortunately, this also impacts eggs and sperm. Eggs are more severely affected because the number of eggs is finite. Once lost, eggs cannot be regenerated. After cancer treatment, a woman should have normal periods, acceptable AMH levels, at least one healthy ovary, healthy uterus, and healthy fallopian tube. Your ability to conceive will also depend on your age, the location of the tumor and the type of treatment you have been advised. We had 7-8 patients who came in with a diagnosis of some form of cancer. Some of them could act in time and preserve their fertility. Others were either in the age range for which poor results were expected or could not afford the treatment. Most of these patients were in the age group of 30 to 44 years. We had a patient with cervical cancer, who underwent an operation to remove the uterus and then scheduled additional radiation therapy. Fortunately, she had time to freeze her embryos BEFORE cancer treatment and can hope to have her biological child when she is ready.

Dr Richa added: “Egg freezing (egg cryopreservation) is a procedure in which eggs are cultured, removed from the ovary and then frozen. Later, the eggs can be thawed, fertilized with sperm in the lab to form embryos, and placed in a woman’s uterus to help her become pregnant. Any woman who wants to have fertility later on and needs cancer treatment now should consider egg freezing as a viable option. It is very important to note that egg freezing should be attempted BEFORE chemotherapy begins.

Dr Veena Aurangabadwala, Gynecologist, Zen Multispeciality Hospital, Chembur said: “Cancer treatment can have a negative impact on reproductive function. Chemotherapy and radiation therapy have adverse effects on the reproductive organs. These treatment options help to kill cancer cells in affected organs, but also damage normal healthy cells in other organs needed for other body functions. Ovarian cancer can also occur at a younger age, and can damage the ovaries and reduce their ability to produce healthy eggs.Uterine cancer usually affects women between the ages of 40-70, less commonly affecting women of childbearing age.During standard surgery for cancer of the uterus uterus or ovary, the doctor may need to remove these organs, which can lead to infertility.

Since chemotherapy is given intravenously, it impacts every organ in the body. Some of these effects reverse over time, after chemotherapy has ended. Radiation from radiotherapy usually affects organs adjacent to the target organ to which the radiotherapy is directed. Young women with blood cancers or intestinal cancers requiring chemo/radiotherapy face fertility problems as a side effect of their treatment. During the pandemic, we have come across 3-4 young women in their 20s and 30s, who developed poor ovarian reserve or missed periods, due to chemotherapy they received for other systemic cancers, such as colorectal cancer or GIST tumor. This number is expected to increase over the next decade as the incidence, awareness and treatment options for cancers in women of childbearing age increase. With advances in science, fertility preservation methods and options, such as medical removal of ovaries, egg banking, egg/embryo freezing, ovarian tissue preservation, and ovarian transposition have developed and are available. An expert will have to decide on a course of action to preserve fertility in women with cancer,” says Dr. Veena Aurangabadwala.

Dr Mullerpatan added: “Radiation therapy given near areas like the abdomen, pelvis or spine will impact the reproductive organs around that area, such as the ovaries. Radiation therapy to the brain can also damage the pituitary gland which sends signals to the ovaries to make hormones such as estrogen which is needed for ovulation. Surgeries performed to fight cancer of the reproductive system or cancer of the pelvic region can damage nearby reproductive tissues, cause scarring and affect fertility. Hormone therapy can disrupt the menstrual process and fertility issues. Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants that involve receiving high doses of chemotherapy and/or radiation therapy can also give women a hard time and cause infertility.

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