Bowel cancer treatment can come with fertility risks and understanding the preservation options available is an important consideration for many bowel cancer patients.
Just as all other side effects are discussed, possible impacts on fertility should be part of any discussions with your treating specialist before starting treatment for bowel cancer.
Women who receive a bowel cancer diagnosis before beginning or completing their families will often have many questions about how cancer treatment will affect their ability to have children in the future.
Bowel Cancer Australia has put together some helpful information about how bowel cancer surgery and treatment can affect reproductive health, what options exist to help preserve fertility before treatment begins, and what alternatives can be considered for building a family after treatment ends.
Some treatments for bowel cancer carry a risk of infertility for women and men. Your specialist should discuss this risk with you when you are diagnosed.
Even if you’re not ready to have a child now, you might want the option to begin or grow your family in the future. Coping with a cancer diagnosis as well as possible infertility can be hard. You might feel that things are moving very quickly with little time to make important decisions. Your specialists can refer you to a counsellor or a fertility specialist.
Fertility in women
Many women diagnosed with cancer during their childbearing years will be able to have children naturally after treatment, but some are at risk for losing their ability to conceive a child or carry a pregnancy.
Surgery that involves removal of the uterus and/or both ovaries in women will cause infertility. In addition, it may cause scarring that can make it difficult to conceive.
Radiation treatment to the pelvic area also damages the ovaries, which are very sensitive to even low doses of radiation. The amount of damage depends on the size of the radiation field, the dose of radiation given and the number of treatments. If the uterus is included in the radiation field, it can be damaged, making it difficult for a woman to conceive and carry a pregnancy.
Chemotherapy can cause temporary or permanent infertility, depending on the drugs and doses used. Your periods may become irregular or stop during treatment. The younger you are, the more likely you are to carry on having monthly periods. If the infertility is temporary, your periods may return six months to a year later. If the infertility is permanent, you may go through menopause and your periods will stop.
The newer biological therapies may affect your fertility, depending on which drug you are having. Speak to your oncologist if you are worried about this.
Your fertility options will depend on how much time you have before your cancer treatment starts and how well you are. The chances of having a baby after fertility treatment vary from person to person. Your fertility specialist can give you an idea of how successful the different fertility treatment options are likely to be.
If you have a partner, you may be able to have your eggs fertilised using in vitro fertilisation (IVF). This will take two to four weeks once you have been referred to a fertility specialist. The embryos can then be frozen and used once you are ready to start a family.
If you don’t have a partner, you may be able to store unfertilised eggs, which you can use in future fertility treatment. This procedure is less likely to result in a pregnancy than using frozen embryos. Some women use donated sperm so they can freeze embryos, rather than eggs.
If there isn’t time to freeze embryos or eggs before your treatment starts, you may be able to freeze tissue from one of your ovaries.
The storage of ovarian tissue and its use in fertility treatments is still fairly new. Your fertility specialist will be able to tell you about this and other possible treatments, if you would like to know more.
Fertility in men
Surgery can cause erection and ejaculation issues and so may affect your fertility. Radiotherapy to the area between the hips (pelvis) usually causes infertility.
Chemotherapy can cause your body to slow down or stop the production of sperm. This can be temporary or permanent, depending on the drug and the dose. If it is temporary, sperm production can take several years to fully recover. If you are having more than one chemotherapy drug, you are more likely to have a low sperm count or stop producing sperm completely.
You will be offered the chance to store some sperm before you start your treatment, and your specialist can tell you more about this.
When to talk to your specialist about your fertility
Although you can talk to your specialist about your fertility concerns anytime, it is best to discuss them early during diagnosis and treatment planning, and before you start any treatment. This allows time for referral to a fertility specialist to learn about your risk of infertility and pursue fertility preservation, if you desire.
Preserving ovarian function after bowel cancer
Chemotherapy and radiation treatment can impact fertility in women with bowel cancer, however there are several standard and investigational treatment options that may be available to preserve fertility among newly diagnosed women.
One surgical procedure, called ovarian transposition, can help protect a woman’s ovaries from being damaged during radiation therapy for rectal cancer by permanently moving them outside the field of treatment.
This minimally invasive procedure reduces the exposure of the ovaries to radiation with the goal of keeping the ovaries working properly and increasing the chances that a woman can conceive a child after cancer treatment, will not go into early menopause, or both.
Even when the ovaries are moved, they may still be exposed to some radiation. Adding chemotherapy to a patient’s treatment plan may increase the likelihood of eggs being destroyed.
In order to improve the chances of having a biological child, patients may also want to consider egg or embryo freezing before treatment.
Both men and women should use contraception during radiotherapy and chemotherapy and for about a year after treatment ends. This is because these treatments can damage sperm and eggs or harm a developing baby.
Assessing fertility and fertility treatment
Fertility options after cancer treatment will depend upon your age and whether you have been through premature ovarian failure or early menopause.
When you are ready to start a family, you may need fertility treatment to have a baby.
Although there are no tests that can reliably predict whether you will be able to fall pregnant and if the pregnancy will be successful, a cancer or fertility specialist will be able to talk to you about your likely fertility status after treatment and any fertility treatment options available.
Family building options after bowel cancer treatment
Not all women will be able or want to freeze eggs or embryos before beginning cancer treatment. However, if you are no longer fertile after treatment, there are still ways to become a parent.
Alternative routes to parenthood can include using donor eggs, surrogacy, and adoption.
The legal and financial implications of these options can be considerable. However, patients should be informed about all the options available to them before beginning treatment, so as to make the best decision they can for their current and future personal circumstances.
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