100 answers about cancer and fertility

Approximately 130,000 of people diagnosed with cancer in the United States each year are in their reproductive years and 1,000,000 cancer survivors are diagnosed during their reproductive years. In "100 Questions & Answers About Cancer & Fertility," discover important answers to some of the most common questions. Read an excerpt:

Men
Understand that treating cancer is going to be the most important thing for a certain period of time, but there may come a day when you are in recovery and might then be glad that you [planned for] a child.

—Lisa, Wife of Esophageal Cancer Survivor

1. What is infertility in men?

For men, infertility is the inability to father a child. It can be further defined as the inability to conceive after 1 year of unprotected

intercourse. In general, infertility occurs when you stop producing sperm or when your sperm is too damaged.

The World Health Organization has developed criteria to measure the normal quantity, speed, and shape of sperm. Anything below these numbers is considered low or compromised:

• Sperm concentration (quantity)—more than 20 million sperm per milliliter of ejaculate

• Sperm motility (speed)—more than 50% moving sperm in ejaculate

• Sperm morphology (shape)—more than 30% of sperm in ejaculate have normal shape

The average man has 60 to 80 million sperm per milliliter of ejaculate. Low or compromised fertility is defined as sperm concentrations of less than 20 million per cc of ejaculate, whereas sterility is generally defined as a complete absence of sperm (azoospermic). Some couples with slightly abnormal values may still be able to achieve pregnancy naturally or by using fertility treatments.

2. Is infertility the same as impotence?

Infertility is not the same as impotence. Infertility does not involve sexual functioning.

3. How do cancer and its treatments affect fertility?

Not all cancers and cancer treatments cause infertility, but some do; thus, it is important to understand your individual risks. Cancer itself can cause infertility in men. For example, some men with testicular cancer and Hodgkin’s disease have low sperm counts before treatment starts. This could be due to the stress of cancer or the direct effects of the tumor.

Cancer treatments can also cause infertility. In general, the higher the dose and the longer the treatment, the higher the chance for reproductive problems. The following factors can influence your risk:

• Age

• Type and dose of medications

• Location and dose of radiation

• Surgical area

• Pre-treatment fertility status of patient

Chemotherapy, radiation, and surgery can all affect your reproductive

system. Table 1 in Appendix A shows whether your cancer treatments might put you at risk for infertility.

Chemotherapy

Chemotherapy kills rapidly dividing cells throughout the body—cancer cells and healthy cells, including sperm. Your age, the type of chemotherapy, and the dose of the medications can influence your risk. Certain chemotherapy agents are more damaging than others. Generally, alkylating agents are the worst.

Radiation

Radiation also kills rapidly dividing cells in or around its target area. For example, radiation to or near your testicles can cause infertility, but radiation to your chest will not. Radiation to your pituitary gland or hormone-producing areas

of your brain may cause infertility by interfering with normal hormone production. The location and dose of radiation will influence your risk.

Surgery

Surgery that removes all or part of the reproductive system, such as one or both of your testicles, may cause infertility. Accordingly, the location and scope of surgery influences your risk.

Bone Marrow and Stem Cell Transplants

Bone marrow transplants and stem cell transplants gen­erally involve high doses of chemotherapy, which increases the risk of infertility. Sometimes full-body radiation is used, which also presents a high risk. The combination of both of these treatments creates an extremely high risk for subse­quent infertility.

Gleevec (Imatinib)

Although research is limited, there seems to be no effect to men’s fertility from Gleevec, and it appears to be safe to father a child while you are taking Gleevec.

During my exam, the doctors found numerous tumors in my lymph nodes and spleen as well as a 6-inch tumor wrapped around my heart. I was shocked to hear the news about my tumors and then completely devastated when the oncologist told me that I might become sterile as a result of my cancer treatment.

—Brian, Hodgkin’s Lymphoma

4. Am I at risk?

Please refer to Table 1 in Appendix A to better understand your risk of infertility after cancer. Research studies have not been conducted on every type of cancer and every type of treatment to evaluate reproductive outcome, and thus, it is not always possible to know your risk of infertility. If you have amore common type of cancer like non-Hodgkin’s lymphoma, testicular cancer, or leukemia, there may be studies to help calculate your risks. Discuss your individual risks with your cancer doctor.

5. Is fertility important to me?

If you are at risk for infertility caused by your cancer treatments,

it is important to think about the significance of parenting to you. You may want to consider whether you want to be a father one day and, if so, whether having a child genetically related to you is important. A few sample questions to ask might be as follows:

• Have I always wanted children?

• Would I prefer adoption to other parenthood options?

• Does it matter to me whether my children are biologically related to me?

• Am I open to using donor sperm or donor embryos?

• How many children do I want to have?

• How does my partner/spouse feel about all of these issues?

Understanding how you feel about parenthood will help you decide whether options such as sperm banking are worthwhile for you. For example, if you would like to have a biological child with your partner, sperm banking may be the best way for you to preserve that dream; however, if you have always wanted to adopt a child or to be a foster parent, then you might decide not to bank your sperm. It is important for you to think these decisions through because they may affect your parenting options for the rest of your life.

WOMEN

When I was first diagnosed, I thought that the only thing that mattered was surviving, but as the weeks ticked by and we were still waiting for the trial to open, I started thinking that there was a possibility that someday this whole cancer thing would be behind me—or at least on the very back burner. I knew if that were thecase, I would really want to have children. I also knew that my treatment might screw that up for me. I didn’t want to be greedy and start thinking about kids before I even took my first dose of Gleevec, but I also didn’t want to look back and regret not doing whatever I could to prevent that from happening.

—Erin, Chronic Myelogenous Leukemia

29. What is infertility in women?

Infertility is when you no longer produce mature eggs for ovulation or when you have some other condition that prevents you from getting pregnant or maintaining a pregnancy. Infertility is commonly defined as the inability to conceive after 1 year of regular unprotected intercourse; however, this definition does not always apply to cancer patients. Women who have been exposed to fertility-threatening treatments should not necessarily wait 1 year. Cancer survivors are usually advised to seek counseling before trying to conceive or after 6 months of unsuccessful efforts to get pregnant.

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