Managing Fertility

It’s common for individuals affected by colon cancer or rectal cancer, especially young adults, to inquire about fertility after cancer treatment. There are many resources and options for those who desire to become parents following a cancer diagnosis.

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When to Ask About Fertility

If you’ve been diagnosed with colon or rectal cancer, it’s important to talk with your health care team about fertility preservation before treatment for colorectal cancer begins. This allows time for you to be referred to a fertility specialist and follow any recommendations. 

If you did not discuss fertility or undergo any preservation steps prior to cancer treatments, there may still be several family planning options for you. 

While conversations about fertility have been added to treatment guidelines for young adult patients and patients of childbearing years, you may need to bring this up with a doctor, especially if you already have children or are single. 

Potential Fertility Complications 

Treatment for colorectal cancer can affect your fertility in a number of ways. Both men and women run the risk of “infertility,” which typically means a failure to have a pregnancy after 12 months of trying. 

For both men and women, the use of certain chemotherapy drugs may damage sperm and eggs. Ask your doctor if your chemotherapy drugs or targeted therapies have been shown to induce infertility side effects.

Radiation therapy can also cause damage that may lead to infertility, namely damage to the testicles and ovaries. For women, surgery to remove or suspend the ovaries and/or uterus can cause infertility. Scarring may also impact a cancer patient’s ability to conceive.

While some cancer patients have experienced troubles with fertility due to cancer treatments, many have also worked with fertility specialists and experienced successful treatments and subsequent births.

Fertility Options

For fertility preservation, there are options for men and women. It’s ideal that a patient be as healthy as possible and avoid tobacco, alcohol, and recreational drugs prior to preserving sperm or eggs.

Men’s Fertility Options

Male cancer patients can freeze sperm, also called “banking sperm,” before they undergo any colorectal cancer treatments. If men struggle to provide a sample, there are other (more invasive) options.

Frozen sperm can be used for:

  • Intrauterine Insemination (IUI—injecting sperm into the uterus)
  • In Vitro Fertilization (IVF)

Women’s Fertility Options

Women have several options when it comes to fertility preservation and cancer treatment. 

Egg and Embryo Freezing

This method is considered the standard of care for young adult cancer survivors. Women take hormones to stimulate ovarian production and a doctor removes the eggs through a minor procedure. The eggs can be frozen as-is, or fertilized in the lab with sperm from a partner or donor, and then frozen as an embryo. 

While embryo freezing has traditionally been a more successful way to preserve a female’s fertility, new technology for egg freezing is showing more promise and success.

Ovarian Transposition

Women facing rectal cancer may consider this option, which suspends the ovaries into the abdomen. By moving them up, the ovaries are outside of the radiation field in the pelvis, yet their hormone function stays in-tact. Women who undergo this method will likely need IVF to conceive and carry a child.

Uterine Transposition

This surgical procedure moves the uterus up in the abdomen to prevent damage from radiation. Once radiation treatment is complete, the uterus is moved back down into the pelvis. There have been a few live births after using this technique.

Ovarian Tissue Freezing

This treatment 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. Although no longer considered experimental, this treatment is not widely available and should be pursued at experienced centers.

Ovarian Suppression

An experimental option that shuts down the ovaries with medication while a patient undergoes chemotherapy so the ovaries are more resistant to the chemo’s effects. The data on this option is inconclusive.

What Do Fertility Treatments Cost?

The cost of fertility treatments varies based on what you do and where you live. Your health plan may also play a role in your out-of-pocket fees; call your health insurance company before undergoing any treatments. On average, treatments can cost: 

  • Sperm banking: $600-$1,200 (Average cost, includes once year of storage)
  • Egg & Embryo freezing: $8,000-$25,000
  • Ovarian transposition: considered a surgery – check with your doctor and health plan
  • Uterine Transposition: considered a surgery – check with your doctor and health plan
  • Ovarian tissue freezing & suppression: ask your doctor

Additional cost factors to consider:

  • Appointment Fees
  • Bloodwork
  • Additional Medications
  • Ultrasounds and Monitoring
  • Storage Fees 

About In Vitro Fertilization (IVF)

In vitro fertilization is not only for cancer patients, but many patients have used it to conceive a biological child. There are several steps involved with a cycle of IVF. 

  • Egg stimulation (through injectable hormones done at home)
  • Egg collection (done via a minor, outpatient surgery)
  • Fertilization into embryos (performed by technicians in a lab using the collected eggs and banked sperm) 
  • Unthaw eggs, sperm, or embryos if frozen
  • Implantation (during another minor, outpatient surgery, the embryo is implanted into the woman)

The success rate of IVF will depend on several factors such as your age, viability of the embryos, and any other fertility or medical problems you may have. If one cycle fails, you may be able to try another. Always talk with your doctor about the success rate of IVF and viability of a pregnancy for you. 

Insurance Coverage for IVF

Several states have passed laws requiring health insurance companies to cover the costs associated with infertility treatments. See The Alliance for Fertility Preservation’s list of infertility laws by state. Before undergoing IVF, check with your provider on what’s in-network, out-of-network, and not covered for you. 

Grants for Cancer Survivors Having IVF

Several organizations recognize the financial strain of costs associated with fertility preservation and offer financial assistance: 

Family Planning for the Cancer Survivor

While there are a variety of fertility preservation options, most ideally done prior to starting cancer treatment, there are other family planning options. 

Should you find yourself unable to take fertility preservation steps prior to starting treatment, or should the therapies turn out unsuccessful for you, here are other ways cancer survivors have built their families: 

  • Sperm, egg, and embryo donations or adoptions
  • Surrogate, also called gestational, pregnancies 
  • International or domestic adoption 
  • Foster care

More Fertility Resources

There is an abundance of information and resources available to cancer patients about fertility.

Fertility Information 

Fertility Stories

Learn more about your fertility options in this Q&A blog with fertility specialist, Dr. Terri Woodard, Associate Professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.