Fertility Preservation
If you’re a young adult cancer patient, one of your first questions may be related to fertility. Colorectal cancer treatment can impact fertility, but there are several steps and resources for you to take.
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.
Before Treatment
Talk with your healthcare team about fertility preservation before treatment 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.
Conversations about fertility have been added to treatment guidelines for young adult patients and patients of childbearing years, but you may need to bring this up with a doctor, especially if you already have children or are single.
Here’s what to ask your doctor if fertility is a concern for you:
- Are any of the recommended treatments likely to impact my reproductive health in any way? If so, how so?
- I’d like to take steps to preserve my fertility. What are my options?
- Can you recommend and refer me to reproductive specialists who could help me with fertility matters when I’m ready?
Potential Fertility Complications
Treatment for colorectal cancer can affect your fertility in many ways. Both men and women run the risk of infertility after cancer treatments. Infertility, which typically means not getting pregnant despite having carefully timed, unprotected sex for one year, can be a side effect of treatment and affect both males and females.
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. 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.
Treatment for colorectal cancer can affect fertility in several ways.
Surgery
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
Chemotherapy can damage sperm and eggs. The amount of damage depends on the type and dose of the drugs a person receives. Ask your doctor if your chemotherapy drugs or targeted therapies have been shown to induce infertility side effects.
Radiation
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 it difficult for a woman to conceive and carry a pregnancy.
How do I find a fertility specialist?
There are several ways to find a fertility specialist. Your doctor may be able to recommend one that he/she has worked with. If not, a 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.
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. Ask them: Can colorectal cancer cause infertility? Be ready for honest conversations.
Fertility Preservation Options
For fertility preservation, there are options for men and women. It’s ideal that you are as healthy as possible and that you avoid tobacco, alcohol, and recreational drugs prior to preserving sperm or eggs.
Men’s 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 Options
Women have several options when it comes to fertility preservation and cancer treatment.
Treatment for colorectal cancer can affect fertility in several ways.
Surgery
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
Chemotherapy can damage sperm and eggs. The amount of damage depends on the type and dose of the drugs a person receives. Ask your doctor if your chemotherapy drugs or targeted therapies have been shown to induce infertility side effects.
Radiation
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 it difficult for a woman to conceive and carry a pregnancy.
Ovarian tissue cryopreservation
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.
Egg and Embryo Freezing
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).
How do I find a fertility specialist?
There are several ways to find a fertility specialist. Your doctor may be able to recommend one that he/she has worked with. If not, a 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.
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. Ask them: Can colorectal cancer cause infertility? Be ready for honest conversations.
Fertility Preservation Options
For fertility preservation, there are options for men and women. It’s ideal that you are as healthy as possible and that you avoid tobacco, alcohol, and recreational drugs prior to preserving sperm or eggs.
Men’s 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 Options
Women have several options when it comes to fertility preservation and cancer treatment.