There are rising rates of people being diagnosed with colorectal cancer before age 50. Being diagnosed with colorectal cancer during early adulthood comes with many challenges – some of which are uniquely different from challenges faced by those diagnosed at an older age.
One of the most prominent differences is how the cancer and cancer treatment can affect fertility.
We took a moment to chat with Dr. Terri Woodard, Assistant Professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, about fertility and colorectal cancer.
Q. How could treatment for colorectal cancer affect my ability to have children in the future?
A. Treatment for colorectal cancer can affect fertility in several ways. 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. Chemotherapy can damage sperm and eggs. The amount of damage depends on the type and dose of the drugs a person receives.
Radiation treatment to the pelvic area also damages the ovaries and testicles, 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 if difficult for a woman to conceive and carry a pregnancy.
Q. When should I talk to my doctor about my fertility?
A. Although you can talk to your doctor about your fertility concerns anytime, it is best to discuss them early in the course of 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.
Q. How do I find a fertility specialist?
A. There are several ways to find a fertility specialist. Often, your doctor may be able to recommend one that he/she has worked with. If not, one good resource is the Society for Assisted Reproductive Technology (SART) website, which has a “Find a Clinic” database that allows you to locate clinics near you (www.sart.org) Most importantly, let the clinic know that you are a patient with cancer who needs to be seen urgently, so that they can evaluate you well before you start cancer treatment.
Q. What options are available for fertility preservation?
Men should freeze (“bank”) sperm PRIOR to receiving any cancer treatment. Occasionally, some men may have difficulty providing a sample so more invasive methods such as electrical stimulation or a testicular biopsy are used. Frozen sperm can be used for intrauterine inseminations (IUIs—injecting sperm into the uterus) or for in vitro fertilization (IVF).
Women have several options for fertility preservation, including egg and embryo freezing, ovarian tissue freezing, ovarian transposition and ovarian suppression.
Egg and embryo freezing are considered to be the most efficacious and standard of care options to preserve fertility. The process involves taking injectable hormones to stimulate the ovaries to ripen multiple eggs at once. Then the eggs are removed in a minor, outpatient surgery. Using ultrasound, the fertility specialist guides a needle through the upper vagina into each follicle on the surface of the ovary, “harvesting” the egg inside. Once eggs have been removed, they can be frozen or fertilized in the lab with the sperm of a partner or a donor. Eggs that fertilize and form embryos are frozen and stored for future use if the patient needs them. This process is called in vitro fertilization (IVF).
Ovarian tissue cryopreservation is an experimental treatment that involves surgically removing an ovary or a portion of one. The tissue is then sliced into small pieces and frozen. Each piece contains hundreds of immature eggs. A few women have been able to get pregnant by having this tissue put back in their bodies after successful cancer treatment.
For women who will receive pelvic radiation that affects the ovaries, ovarian transposition can be considered. This involves surgically moving the ovaries up and out up the pelvis and thus, out of the radiation field. While preserving ovarian function, it may require a woman to undergo IVF to become pregnant.
Ovarian suppression is another experimental option for preserving fertility. Using a medication called a GnRH agonist, the ovaries are shut down into a “quiet state.” It has been suggested that ovaries that are suppressed during chemotherapy are more resistant to its effects. However, the data is not clear whether it truly works or not.
Q. Are there any lifestyle modifications I’ll need to make during the process?
A. It is recommended that you be as healthy as possible by eating a balanced diet, exercising and avoiding tobacco, alcohol or drug use.
Q. What is the cost of fertility preservation?
A. Fertility preservation is expensive, and costs can vary widely between geographic regions. For sperm banking, the average cost is $400-$600, which includes one year of storage. There may be additional costs for infectious disease testing. For egg and embryo freezing, the average cost ranges from $8,000-$12,000 per cycle. Some people have insurance coverage that will cover the cost of it—you should always call your insurance company to see if you have fertility treatment benefits.
If not, there are several programs in place that help subsidize the cost of fertility preservation for individuals diagnosed with cancer, including the LIVESTRONG fertility and Walgreens Heartbeat programs. Some long-term storage facilities that store sperm, eggs and embryos also offer discounts to patients with cancer.
Individual clinics may also offer discounts if they know you have been newly diagnosed with cancer. In addition, people have come up with novel ways to pay for fertility such as by applying for grants and setting up accounts on platforms such as GoFundMe.
Q. What is the success rate?
A. The success rate of fertility preservation depends on multiple factors, including age, the quality of sperm/eggs or embryos at the time of treatment and the presence of any other fertility problems. It is important to speak with your fertility specialist to get an accurate estimate of your success rate.
*Please note that for some people, more than 1 cycle is needed.
Q. What are my options if, after treatment, I am infertile?
A. If you become infertile after cancer treatment, there are several ways that you can build your family. If you previously stored sperm, eggs or embryos, they can be thawed and used to have a child.
If you do not have frozen sperm/eggs/embryos, you may wish to use third party reproduction. Third party reproduction is the use of eggs, sperm, and/or embryos that have been donated by a third person (whom we refer to as a donor) to enable an infertile individual or couple (known as the recipient(s)) to become parents. Donors may be known or anonymous.
For women who are unable to carry a pregnancy, gestational carriers are a good option. A gestational carrier is a woman who agrees to carry a pregnancy, but she is not genetically related to the child.
Adoption is another wonderful way to build a family. There are many different types of adoption agencies and adoptions, so it is important to learn about the process and what is involved.
Q. Any suggested resources?
A. There are many wonderful online resources where you can learn about fertility. These include:
For more resources on fertility, check out Andi’s Blog “Protecting Your Fertility” and read rectal cancer Ashley’s experience with a successful IVF.