Education Resource from the Society for Endocrinology
J Stewart
International Centre for Life, Newcastle upon Tyne
Summer School 5-8 July 2005
St Aidan’s College, Durham University, Durham, UK
Treatment for cancer is often destructive in many ways and not always predictably. There are numerous aspects of the various modes of cancer treatment that may have adverse effects in the short or long term in relation to fertility. Whilst the potential effects on fertility should be discussed where relevant before such treatment, fertility preservation techniques remain relatively limited except for sperm storage for men which is now increasingly offered.
Following treatment there are a number of factors which may affect reproductive function not all of which are obvious and in addition an individual may hope for advice in the knowledge that they may have a problem before “testing” their fertility or indeed prior to embarking on a relationship. Primary assessment of fertility in an individual who has undergone cancer treatment requires an understanding of that treatment.
Surgery to the reproductive tract may have an obvious effect on fertility eg. removal of a gonad or the uterus but more distant surgery may also have an effect such as neurological effects on sexual function; erectile and ejaculatory.
The effect of radiotherapy to the gonads may be profound but radiotherapy to the pituitary gland may confuse the diagnosis of premature ovarian failure in a woman who has also received chemotherapy. Radiotherapy to the pelvis may also disrupt uterine function resulting in complicated pregnancies even when fertility treatment is successful.
It is well known that chemotherapy can have a devastating effect on gonadal function but this can be variable and at times idiosyncratic. It is generally dose and duration dependent but also, particularly in women, dependent on gonadal reserve which is age related. In addition the recovery period of the gonads from the effects of serious ill health may be variable and also confounding.
Surviving cancer may give individuals a different perspective of life but they may also have to deal with the stigmata of their disease and its treatment both outward eg. loss of a limb, surgical scarring and inward; effects on self confidence, interpersonal relationships and their ability therefore to establish and bring to fruition a mature sexual relationship. This is particularly pertinent where the treatment was in childhood and issues relating to puberty may then co-exist.
Fertility assessment therefore requires sensitivity and some lateral thinking. It is also important that if they present as a couple for assessment, that the fertility potential of the partner is also taken into account since this can have significant effects on the outcome of any treatment offered and may preclude some treatments altogether.
The range of fertility treatments available to cancer survivors who need them, are the same as for other couples who are subfertile and the choice of treatment will depend on both the outcome of the fertility assessment and the couple’s preference. Treatment may range from simple insemination of the male partner’s pre-frozen sperm, to the use of donor gametes or to in vitro fertilisation with embryo transfer to a surrogate.
It should be remembered however, that a large part of the management of fertility
problems does not relate to “making babies” but to reassurance
or to the consideration of the alternatives of remaining childless, adopting
or fostering. Primarily the aim is to help individuals or couples come to terms
with the limitations of their reproductive function. A successful failure can
be as rewarding as the achievement of pregnancy to doctor and patients alike.
The opinions expressed in this paper are those of the speaker and do not necessarily reflect the views of the Society
Revised:
28-Jul-2005