Family Planning Options
Once you've spoken with your doctor about whether your treatment can affect fertility, you may want to know more about family-planning options. There are several options that may help you, or your child, preserve the ability to have children in the future. Your options depend on several factors, including:
- your age at the time of diagnosis and treatment
- the type of cancer
- the type of treatment
- your family planning objectives
Adoption is a good option for some people after cancer treatment. Generally, people free of disease after treatment are eligible to adopt infants or children, but policies vary from one area to another. For more information, contact an organization such as Fertile Hope and Resolve.
Options for Males
Males can take certain steps and precautions to preserve fertility before, during and after treatment.
- Sperm banking. You can donate sperm cells to be frozen (sperm cryopreservation) and stored for later use (after puberty only). This fertility preservation option has the highest likelihood of success.
Before or After Treatment
- Testicular sperm extraction (TESE). Your doctor can remove sperm cells found in tissue taken from your testicle. Any sperm cells found can be used right away or frozen for later use (sperm cryopreservation). Although sperm cells can be extracted before or after puberty, in prepubescent boys TESE is considered an experimental procedure.
- Testicular tissue freezing. This procedure involves removing and freezing testicular cells. However, it's not yet resulted in pregnancy and is still considered an experimental technique. More research is needed.
- Radiation testicular shielding. If possible, the doctor puts external shields over the your pelvic area to protect it from the radiation's effects.
- Donor sperm. Sperm can be donated for your use by a fertile donor to produce a pregnancy through artificial insemination.
Options for Females
- Ovarian transposition. Your doctor surgically moves the ovaries away from the radiation field to minimize exposure and radiation damage.
Before and After Treatment
- Ovarian tissue freezing. Part or all of the ovary is removed and frozen for later use (after puberty only). This is still an experimental approach to fertility preservation.
- Embryo freezing. Mature eggs are removed, fertilized with sperm from your partner or a donor and then frozen and stored (after puberty only). Egg stimulation and harvesting to create an embryo to freeze typically takes at least three to four weeks. This option has the highest likelihood of success for females.
- Egg freezing. Mature eggs are removed, frozen and stored without being fertilized with sperm (after puberty only). Egg freezing is less effective than embryo freezing and considered an experimental procedure.
- Ovarian shielding. If possible, the doctor puts external shields over the site of the ovaries to protect them from radiation to the abdomen.
- Gonadotropin-releasing hormones (GnRHs). This medication is used during chemotherapy to try to help lessen fertility damage. This is an experimental approach to fertility preservation.
- Donor embryos. This option enables you to become pregnant with a donated embryo that would unlikely be related to you.
- Donor eggs. You can receive donated eggs fertilized with your partner's sperm.
- Surrogacy. If you're unable to carry a child, surrogacy may be an option. Surrogacy arrangements vary depending on whether you're fertile or infertile. A traditional surrogate is usually a woman who becomes pregnant through artificial insemination of your partner's sperm. The surrogate provides her egg, carries the pregnancy and is the genetic mother of the baby. A gestational carrier is a healthy woman who receives an embryo created by the intended parents. If you're interested in this option, you should seek more information from a fertility specialist.
Females who are fertile after treatment but not ready to become pregnant may be at risk for premature ovarian failure (POF) and lose the ability to conceive. You may want to take precautions by considering embryo freezing, egg freezing or ovarian tissue freezing.
Most women of childbearing age who've been treated for cancer and are able to conceive can go on to have normal pregnancies and healthy babies. You should be able to become pregnant if treatment didn't affect your ovaries or uterus. Before attempting conception, talk with your oncologist about your medical readiness for pregnancy. You may also want to consult with an obstetrician for a fertility assessment.
Even though some drugs used to treat cancer, such as imatinib (Gleevec®), usually aren't associated with fertility loss, you should avoid taking them if you're pregnant. However, never stop medication without your doctor's advice. If you're taking imatinib or any other cancer drug, consult your oncologist before you try to conceive or if you think you're pregnant.
Talk with your doctor about whether you'll be able to breastfeed during or after treatment. You shouldn't use certain drugs while breastfeeding. If you've had radiation to the breast area, your ability to produce milk may be affected.