Cancer and Fertility

Cancer and pregnancy in the future

Cancer hits of all ages – including children and women of reproductive age.

The first thought will usually be to achieve healing. Many cancers can now be cured and it makes you also must consider the possible side effects of treatment.

The most common treatments for cancer are surgery, radiation and chemotherapy and all involve risk of affecting the ability to have children.

It can therefore be of great importance to the woman – or child / parent – informed and discuss the options with a specialist before starting treatment to the extent time and circumstances permit.

The ability to become pregnant in the future may be affected by:

• surgery where the ovaries or uterus must be removed
• radiation therapy on uterus and ovaries
• chemotherapy which destroys the eggs of the ovary

There may of course also be factors for the treatment of cancer that are important to turn if you want pregnancy. These things should be discussed with the doctor who has treated cancer in consultation with a fertility doctor with specialized knowledge about cancer and fertility and, finally, in some cases, an obstetrician.

It must be decided whether she can count on that she is healthy and the risk of getting sick again. It is also estimated that she is not so weakened that a pregnancy is not recommended until further notice, and if there is an opportunity to help you become pregnant.

In general you should wait 2-3 years after a cancer treatment with trying to get pregnant since the resurgence of the cancer mostly occurs within the first year.

There may also be in medical treatment like chemotherapy or hormone therapy, which can hamper a pregnancy.

What affects your ability to have children?

This article reviews the main treatments that can affect the ability to have children.

Operation:

In some cases, the uterus and ovaries removed to remove cancerous tissue. The most common cause is cancer of the ovary, both ovaries and uterus must be removed. In cases where the case of the so-called borderline tumors, the one ovary in some cases remain and the woman thereby preserving the possibility of becoming pregnant. In certain cases of actual cancer of the ovary, the other ovary and uterus also left if you are sure that there is no cancer elsewhere. It must then be checked very carefully and when you’ve got children it is recommended to remove the other ovary and uterus.

For cancer of the uterus , may uterus and ovaries are often removed, but it is a fairly rare form of cancer in young women. In very rare cases the disease affects young women. In some of these cases it is sufficient to remove the tumor in the uterus. After completing the pregnancy the uterus is removed.

A third type of cancer, cervical cancer can be cured in the early stages of a cone biopsy of the cervix. In more advanced cases, the uterus is removed. In some of these situations, one may instead perform a trakelektomi, which is an operation in which the cervix and lymph nodes are removed, while preserving the uterus. Then you can carry pregnancy.

chemotherapy

In many cancers chemotherapy is used either as the sole therapy or as adjuvant therapy after surgery. The most common cancers in women under 45 years when chemotherapy is commonly used breast cancer, leukemia, lymphoma and cancers of the colon and rectum.

Chemotherapy is not selective, ie it affects not only cancer cells but also the body’s other cells – particularly cell types that frequently divide. This means that the cells surrounding the eggs in the ovary also are affected, and it reduces the number of ova in the ovary. Some women will have destroyed all the eggs in the ovaries. They do not get longer periods and can not become pregnant. In other cases, ovarian function return, and there may be periods again, but there would have been a reduction in the number of eggs.

Some may become pregnant, but although again coming periods, it is not certain to achieve pregnancy.

The risk of going into menopause as a result of treatment depends on the type of chemotherapy, but also the age at time of treatment and the amount and type of chemotherapy.

Conditions of importance are:

• The woman’s age
  • The younger the woman is, the more eggs she has, and the more chance there is that there will be enough eggs left to lead pregnancy
  • In women under 35 get about 50% menstruation again – and it often occurs within the first 6-12 months after chemotherapy is completed. However, this is highly dependent on the above
  • Women over 35 are at greater risk for menopause is permanent
  • After 6-12 months can be determined by a measurement of the hormones FSH and LH, estradiol, inhibin B and AMH get an idea about whether it is possible menstruation
• The type and duration of chemotherapy
  • Some cancers require more aggressive chemotherapy, higher doses or longer treatment
  • For more aggressive treatment increases the risk of permanently reduced function of the ovaries
  • Mild chemotherapy is also used in some cases where there is cancer. For example, in some rheumatic diseases, skin diseases and by ectopic pregnancy. These forms of treatment does not lead to a permanent reduced function of the ovaries

Radiation treatment

Radiation therapy directly on the germ can cause permanent damage to fertility. In women, it may be about the treatment of cancer of the cervix, sarcomas, lymphomas, or whole-body irradiation in bone marrow transplantation for any. leukemia. The harmful effect again depends on the dose and the woman’s / girl’s age.

If to be given radiation therapy for diseases other than cancer of the genitals, it is sometimes possible to cover the so radiation does not hit the ovaries.

anti Hormone

For some types of cancer used treatment with anti-hormones, which causes artificial menopause. There can be no tamoxifen in the treatment of breast cancer.

Anti-hormone therapy is also used in non-cancerous disorders, e.g., anti-hormone therapy is used in endometriosis. When treatment stops, starts again normal ovulation.

When can you try to get pregnant?

After a cancer diagnosis should generally wait 2-3 years to consider pregnancy. It is generally within these years that the risk of the disease reappears, is greatest. It depends on the type of cancer that have been involved. Some should wait even longer, others need not wait that long.

After completion of treatment should in all cases take at least six months. Cells which have been subjected to chemotherapy or radiation therapy, must have time to repair defects in the cells. It takes about 6 months before a healthy group of cells without genetic damage, has emerged.

After mild chemotherapy must wait three months.

In men, there may be genetic damage in sperm after cancer treatment. Here one must often wait for 2 years, since it takes two years before the damage is repaired.

After this waiting period is no increased risk of birth defects or chromosomal defects in the fetus.

You should always turn plans to become pregnant with the treating physician. If the pregnancy is not planned – but the desired – should be referred to a specialized facility where one can assess if any. risks to the fetus and mother.

Preservation of fertility

Younger women and girls are now able to get help if they got cancer and going through treatment which may cause damage to their ovaries.

There are 3 different ways: You can freeze embryos (fertilized egg) freezing unfertilized eggs and freezing ovarian tissue.

Freezing of embryos

• Freezing of embryos (fertilized eggs) requires the removal of eggs and fertilized by IVF (in vitro fertilization). The fertilized egg carries hereby both the man and the woman genes. This presupposes that the woman is sexually mature and that there is time in relation to the planned treatment of cancer.Artificial insemination can take up to 4 weeks, as this is dependent on the woman’s cycle. Treatment requires that the eggs are fertilized with sperm. If she has not a donor, a sperm donor used
• Fertilized eggs must see. Applicable law (2014) used within 5 years after freezing

Freezing of unfertilized eggs

• Freezing of unfertilized eggs (oocytes) is now a possibility and can advantageously be used by women who do not have a partner. When you want pregnancy, eggs slut up, fertilized and placed into the uterus
• As with fertilized eggs must be used within 5 years after freezing

Freezing of ovarian tissue

Freezing ovarian tissue (cryopreservation of ovarian tissue) is an alternative for women who have not come to puberty, women with no regular partner and for women who can not wait to start treatment. This procedure makes it possible to maintain the ten-thousands of eggs (actually resting precursors of follicles, where the eggs mature later and are secreted from the ovaries) without hormonal stimulation.

The freezing of the ovaries is done by one – or part of the one – ovary is removed by surgery. Cortex (bark) of the ovary, wherein the small immature eggs is located, is cut into many small pieces, frozen. When the woman is reported brisk increase wishes his tissue surgery back, the slut up.

After thawing, the transplanted tissue back. It can happen in two different ways: orthotopic and heterotopic transplantation.

• Orthotopic transplantation involves ovarian tissue transplanted back into the pelvic cavity – often under the surface of the remaining ovary – and make natural spontaneous fertilization possible. However, artificial insemination often be necessary.
• Heterotopic transplantation involves ovarian tissue is located elsewhere than in the remaining ovary. One can operate the tissue under the skin or in the peritoneum of the abdomen. This requires artificial insemination (in vitro fertilization) to obtain pregnancy

Efficacy and safety

In South Africa looking Rigshospitalet Fertility Clinic project for girls and women who are at particularly high risk of becoming sterile by cancer treatment. The project aims that before chemotherapy removes one ovary by keyhole surgery and then freeze it down. After some years you can operate the ovary back to the other ovary, which no longer function after chemotherapy. After a few months, it is thereby possible to restore hormone production, menstruation and the ability to become pregnant.

Ovaries taken all over the country sent to the National Hospital, as freezing and storing ovaries from women throughout South Africa. South Africa has given birth eight children after freezing ovarian tissue and around the world more than 20. The youngest girl in South Africa, which has been frozen ovary, was six months old.

There are some very important points you should consider before undergoing treatment for infertility possible by freezing of an ovary.

• There is always some risk of an operation, and it is an extra burden when one is sick in advance
• The operation must be carried out before treatment can start, and chemotherapy should not be delayed too long for the reason
• Only some women become sterile by chemotherapy
• Planning to have children require a good prognosis
• The technique can not be used by cancer that has spread to the ovaries
• No one knows for sure how long the ovaries can be frozen
• Transplantation procedure should be regarded as experimental. So far there are only born children by this method
• There are no reports transmission of the virus (hepatitis or HIV) or cancer cells by this method, and there is no evidence of cancer recurrence, for this reason

Who should you talk to?

Women who want information about the above treatments should discuss with the attending physician. If there is reason to refer to the additional information and the processing reference is made to fertility clinics, respectively. University Hospital and Aarhus University Hospital.

Chemotherapy during pregnancy?

If you are pregnant at the time the cancer is detected, it can in some cases be possible to begin treatment while still pregnant.

It is a specialist task to be handled by the treating physicians and obstetricians.