Cancer, chemotherapy and fertility

Chemotherapy can reduce fertility but it is still possible for a woman having chemotherapy to fall pregnant after treatment, as well as for a man to father a child after undergoing chemotherapy treatment.

Certain chemotherapy drugs don’t affect fertility while others may temporarily or permanently prevent the ovaries from producing eggs, causing menopausal symptoms to occur. About a third of women start producing eggs again after discontinuing treatment, although this may take a few months, depending on a woman's age. This is referred to as short term infertility.

It is important to know prior to a patient starting chemotherapy treatment that fertility is likely to be affected. At this stage, it is wise to look at the various options available, such as the freezing of embryos or eggs, as the treatment of cancer may cause infertility and premature ovarian failure as well as premature menopause.

Some cancer treatments damage or destroy the entire egg reserve, causing the onset of menopause immediately after treatment. Even if the entire egg reserve is not destroyed, most treatments will most likely damage to some of the ovarian reserve which causes menopause to occur earlier than normal.
In women, only the treatment of cancer can cause infertility and not the cancer itself.

Certain factors play an important role in causing infertility in cancer patients, such as the fertility status of the patient at the time of diagnosis, her age, the amount of chemotherapy and radiation required and the area of the radiation treatment.

Chemotherapy alkylating agents are the worst types and can damage or destroy eggs. Radiation can damage the reproductive system if the cancer is in the pelvic area or the pituitary gland which interferes with hormone production.

Full body radiation required in bone marrow and stem cell transplants usually require very high doses of chemotherapy and full body radiation, presenting a high risk of infertility.
Surgery to parts of the reproductive system such as the removal of the ovaries, uterus or cervix can also cause infertility.

Male infertility regarding cancer and chemotherapy
Certain chemotherapy drugs may reduce a man's sperm count and affect his ability to fertilize an egg. Particular types of cancer can also cause infertility in men, such as testicular cancer and Hodgkin's disease.

If infertility is not affected by the cancer itself, then it is possible to store sperm for later use, before chemotherapy treatment begins. Many men's sperm count returns to normal after chemotherapy treatments end, sometimes taking a few years, while others remain permanently infertile. Mostly, it depends on the length and the strength of the radiation or chemotherapy treatment. Other factors include the location of the cancer, the patient's age at the time of diagnosis and the fertility status of the patient pre-treatment. It is important that the doctor treating the cancer discuss the topic of infertility in depth with the patient, no matter how young the patient may be, before the start of chemotherapy treatment.

The purpose of chemotherapy is to kill the dangerous cancer cells, dividing rapidly in the body. Unfortunately chemotherapy also kills healthy cells, including sperm cells. Alkylating agents are the most damaging to sperm.

The purpose of radiation therapy, is to kill dangerous cancer cells in and around the area where the cancer is, therefore radiation treatment around the testicles is particularly dangerous as it can kill sperm permanently. Another risky area as far as fertility goes, is the pituitary gland, as this is where hormones are produced.

Fertility is also obviously affected by certain surgical procedures to remove cancer, such as the removal of the testicles in testicular cancer.