For many families in which one or both partners have had cancer, getting pregnant requires special work and planning. The good news is that cancer treatments that once would have left someone completely infertile may now be used more sparingly, and there are now techniques that can preserve fertility despite cancer.
While these new options are available, there are still people with cancer who are not being offered that fertility preservation treatment — either because they forget or don’t know to ask, or doctors forget to offer it.
One thing is abundantly clear: If you are interested in preserving fertility and you have a cancer diagnosis, it’s important that treatment is offered and started as early as possible, according to recommendations from the American Society of Clinical Oncology.
Fertility preservation in men with cancer
In men, there are a couple of ways that cancer can alter fertility. The first and simplest is that the cancer directly alters the ability to make or transport sperm. Chemotherapy, radiation, and surgical techniques used to treat cancer or its complications can also potentially damage fertility. The benefit for most men is that new sperm is made constantly.
One of the most common ways to preserve male fertility is called sperm banking. Prior to treatment, several semen samples are given and banked or stored for later use. Sperm banking can be used in conjunction with intrauterine insemination (IUI) or in vitro fertilization (IVF), with or without intracytoplasmic sperm injection (ICSI).
Only about 10 percent of banked sperm are ever used. Men also may be reluctant to come back to have their fertility tested after cancer via semen analysis, or sperm count. While this follow-up may help them understand their current fertility after cancer and/or treatments, it is not an option many men choose.
Fertility preservation in women with cancer
When it comes to fertility, women with cancer may face a more complex situation than men. In addition to thinking about the genetic material that they supply as a part of the reproductive process (in this case, the eggs), women with cancer also may experience difficulties with their ability to conceive and carry a baby to term.
Fertility preservation in women is mostly focused on the eggs or oocytes. The preferred treatment is to help ripen some eggs with medicine, harvest them, fertilize them with sperm, and store the embryos for later use. But there are many barriers to this treatment.
First, this process has to begin before cancer treatment begins, so you may not have the luxury of the time needed to go through this cycle, which may take more than six weeks (in an ideal setting). You must also have a partner to donate the sperm, or you must utilize a sperm bank. Financial barriers may be an issue as well because many insurance companies will not pay for this treatment. And if you are a teen or young girl with cancer hoping to potentially get pregnant later in life, this may not even be an option.
Newer fertility techniques are becoming available too, like ovarian tissue cryopreservation, where part of the ovary is stored after it is surgically removed, but prior to treatment. This is also an option if ovarian stimulation might make matters worse in terms of the cancer. Note that many of the ways we work to preserve female fertility during cancer treatment are considered new, and there is still much work to be done to make them reliable options.
While there is not complete data available, the general consensus is that, for women who have a low risk of cancer recurrence, they should be able to get pregnant and give birth (and, depending on the situation, breastfeed). Even if you have had cervical cancer, you have a good chance of not only conceiving, but of giving birth without complication.
Breastfeeding after breast cancer
Breast cancer poses its own problem related to having children. While many women maintain their fertility after breast cancer, they may wonder whether they will be able to breastfeed or not. While the majority will be able to breastfeed without issue, some may be advised to only breastfeed on the unaffected breast, or they may only have one breast from which to feed. There have been cases of mothers making a full milk supply, even with only one breast or one breast being actively used during lactation. It has also been shown that pregnancy after breast cancer does not increase the likelihood of a relapse or recurrence.
The bottom line
If you have had a cancer diagnosis and are hoping to build a family in the future, getting adequate counseling and help with funding may make these fertility treatments and pregnancy after cancer more likely to happen. It is not simple process, and it can take time, but having children is possible after cancer once barriers are overcome. There are also options for expanding your family beyond “traditional” pregnancy; these may include using donor sperm or eggs, using a surrogate, or adoption. There is no one right answer for every family.