What you should know about gynaecological cancers and fertility preservation
Gynaecological cancers can impact a woman's reproductive capacity, and the treatments for these cancers may have implications for fertility.
Cancer treatments such as surgery, chemotherapy, and radiation can affect fertility by damaging or removing reproductive organs, disrupting hormonal function, and causing ovarian failure.
The impact on fertility varies depending on the type and stage of cancer, the specific treatments received, and the woman's age. Fertility preservation options are typically considered before cancer treatment begins. Fertility preservation plans need to be coordinated with the overall cancer treatment plan and timing and feasibility of fertility preservation may be influenced by the urgency of cancer treatment.
Fertility sparing hormone treatment for endometrial cancer
Some early stage endometrial cancers can be treated with hormone therapy, which removes the need for surgery that results in infertility. The primary hormone therapy for hormone-sensitive uterine cancer involves the use of laboratory-produced progesterone. Elevated doses of progesterone are accessible in tablet form, typically as medroxyprogesterone, or, in cases where a hysterectomy has not been performed, via a hormone-releasing intrauterine device (IUD) known as Mirena. Your doctor will insert the Mirena into the uterus.
Fertility sparing surgery for ovarian cancer
Unilateral salpingo-oophorectomy is a surgery that removes one ovary and its connected fallopian tube. This procedure leaves the other ovary, fallopian tube and the uterus intact. It may be done for medical reasons like ovarian cysts or tumours, and in some cases, early-stage ovarian cancer. This procedure is considered in cases where the disease is limited to one ovary and the woman wishes to retain the ability to have children in the future. The term "unilateral" means it involves only one side of the reproductive system.
Fertility sparing surgery for cervical cancer
A trachelectomy is a surgery for early stage cervical cancer that removes the cervix only. This procedure does not remove the uterus, meaning it may be possible to become pregnant in the future. The likelihood of experiencing a miscarriage and delivering prematurely is elevated in patients who have undergone this procedure. Additionally, it will be necessary to have a Cesarean section (C-section) rather than a vaginal delivery.
Uterine Transposition for rectal cancer
Uterine transposition has emerged as an alternative for fertility preservation in women with rectal cancer that require radiotherapy. If women require radiotherapy to the pelvis this will damage not only the ovaries but also the uterus. The laparoscopic transposition of the uterus involves moving the uterus and ovaries out of the radiation field. This means repositioning the uterus temporarily to the patient’s upper abdomen. After the radiation treatment is completed the uterus and the ovaries are repositioned into the pelvis, back to its normal position. This allows the uterus to retain its fertility.
Speaking to a fertility specialist
In my practice, we link patients with fertility specialists for reproductive care to discuss some of the below options.
- Egg Freezing (Oocyte Cryopreservation): Harvesting and freezing mature eggs for later use in in vitro fertilization (IVF).
- Embryo Cryopreservation: Freezing fertilized embryos for later implantation.
- Ovarian Tissue Cryopreservation: Freezing and preserving ovarian tissue for potential future transplantation or use.
A cancer diagnosis and fertility preservation decisions can be emotionally challenging. Supportive care, counselling, and resources for emotional well-being are also important components of the overall care plan.
Research and technological advancements continue to improve fertility preservation options for cancer survivors. Discussing fertility preservation options early in the cancer treatment planning process allows for informed decision-making.
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