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Ovarian Cancer and Fertility Loss

Medically Reviewed by Brunilda Nazario, MD on May 10, 2021

Ovarian cancer treatments can affect your fertility or even cause infertility. If you’ve been diagnosed with cancer and think you’d like to get pregnant later on, there are ways to preserve your fertility before cancer treatment begins.

What is fertility loss?

Fertility loss or infertility in women means you’re unable to conceive or carry a pregnancy to term. Your cancer treatments may damage or remove reproductive organs like your ovaries or uterus, damage nerves, or block hormones that are involved in fertility or conception.

Things that affect your risk of fertility loss due to cancer treatments include:

  • Age
  • Current fertility, such as if you’re past puberty or in menopause
  • The cancer treatments you’re having
  • Dose or duration of treatment

When to ask about fertility

Before you start ovarian cancer treatment, ask your health care team about possible fertility loss or birth defects if you get pregnant while on treatment. Your doctor can go over treatment options to reduce the risk of fertility loss or to preserve your fertility.

Even if you haven’t thought about fertility loss or family planning before your cancer diagnosis, ask your doctors to go over your options now.

Cancer treatment and fertility loss

Some cancer therapies may lead to fertility problems or infertility:

Surgery. Hysterectomy (removal of your uterus) or oophorectomy (removal of both ovaries) both cause fertility loss. But if you have a trachelectomy (removal of just the lower part of the cervix for cervical cancer), you may still be able to get pregnant.

If your ovarian cancer is diagnosed in early stages or if you have a type of ovarian cancer called a germ cell tumor, you may need to have only one ovary removed and preserve your uterus. You may still be able to get pregnant. Surgery to remove tumors near your reproductive organs may cause scarring that blocks eggs from moving into your ovaries for fertilization.

Chemotherapy. Some chemotherapy drugs can cause your ovaries to stop making estrogen or releasing eggs. This is called primary ovarian insufficiency (POI). It may be temporary or permanent. Alkylating agent drugs such as busulfan, cisplatin, cyclophosphamide, ifosfamide, and melphalan most often cause POI. Chemo drugs may also reduce the number of healthy eggs in your ovaries and affect fertility. Chemo may also cause early menopause and infertility.

Infertility is more likely with certain chemotherapy drugs, especially at higher doses or in combination treatments, or when paired with radiation treatments. There are chemo drugs that have a lower risk of infertility.

Radiation therapy. Radiation for cancer in your pelvic area or lower belly can destroy eggs stored in your ovaries. Radiation can also scar and damage your uterus so you may not be able to carry a pregnancy to term, causing miscarriage. Radiation to your brain may damage your pituitary gland, which releases hormones needed for egg release, and cause fertility loss.

Hormone therapy. Drugs that block hormones involved in some cancers may cause infertility, but in some women, fertility returns after treatment. Some hormone therapies cause permanent fertility loss. One hormone therapy, tamoxifen, can cause birth defects, so you shouldn’t take it and try to conceive.

Targeted cancer drugs and immunotherapy. The targeted drug bevacizumab may damage ovaries. Drugs like lenalidomide and thalidomide, or immunotherapy drugs called tyrosine kinase inhibitors, may cause severe birth defects if you conceive during treatment.

Bone marrow or stem cell transplants. These treatments involve all-over, high doses of chemotherapy and radiation and can permanently damage your ovaries.

Fertility preservation

If you want to preserve fertility before cancer therapy, ask your oncologist to refer you to a fertility preservation clinic. They’ll go over your options for fertility preservation based on your age, type of tumor, and your cancer treatment plan. Ask questions about the cost and success rate of each fertility treatment option.

Fertility preservation options for women include:

  • Freezing eggs, or cryopreservation, where eggs are removed from your ovaries, frozen, and preserved for fertilization later
  • Embryo freezing or banking, where eggs are removed and fertilized in a lab with sperm to produce embryos that are frozen

Later on, you may be able to get pregnant with these preserved eggs or embryos through procedures like in vitro fertilization (IVF) or with a surrogate mother. Both egg and embryo freezing take about 2 weeks. You’ll take daily hormone shots to stimulate your ovaries to make eggs, then have an outpatient procedure to remove your eggs so they can be frozen or fertilized.

Ovarian tissue freezing is used to preserve fertility in girls who haven’t gone through puberty yet. A doctor removes part or all of one ovary and freezes it. They can thaw and replant it later on when you’re ready to conceive.

Ovarian shielding is a shield placed over your lower abdomen that protects your ovaries from damage during radiation treatments.

Ovarian suppression involves monthly shots of a drug called leuprolide. It blocks ovary-stimulating hormones and may protect your eggs from the effects of chemo. You start it 1-2 weeks before chemo and continue throughout your treatment. You may have menopause symptoms like hot flashes or vaginal dryness.

Ovarian transposition surgery moves your ovaries away from radiation beamed at nearby tumors. Your doctor can do it as laparoscopic surgery with a small cut. It helps protect your ovaries so you can try to conceive later.

Gonadotropin-releasing hormone agonist (GnRHa) therapy can block your body from making estrogen and progesterone, which may protect your ovaries during cancer treatment.

Coping with fertility loss

You may not have thought about starting a family yet at the time of your diagnosis. Once you realize cancer or your treatments could cause infertility, you may feel grief, anger, guilt, shame, or low self-esteem.

Reach out to your cancer doctors or nurses, your spouse or partner, family, friends, or cancer patient support groups for support. A therapist or counselor can help you cope with your loss and stress too.

If you choose not to try fertility preservation but do want to start a family after cancer treatment, here are some other options:
Use donor eggs or embryos.

  • Adopt.
  • Engage a surrogate to conceive a baby with your partner’s or donated sperm through artificial insemination.

 

Show Sources

SOURCES:

National Cancer Institute: “Fertility Issues in Girls and Women With Cancer.”

Memorial Sloan Kettering Cancer Center: “Fertility Preservation: Options for Women Who Are Starting Cancer Treatment.”

American Cancer Society: “How Cancer and Cancer Treatment Can Affect Fertility in Females,” “How Cancer and Cancer Treatment Can Affect Fertility.”

Target Ovarian Cancer: “Sex, intimacy, and fertility for younger women with a diagnosis.”

CancerCare: “Coping With the Loss of Fertility.”

 

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