Fertility preservation with cancer
Is it possible to have children after cancer therapy?
For most people, the thought of having their own children is very distant at the moment of a cancer diagnosis. The bad news is too existential. But it is only at this moment that in the vast majority of cases there is a chance of preserving fertility.
The therapies to treat cancer available to us today are in many cases much more effective than they were a few years ago. A gratifying number of young patients beat the disease and would principally be able to start a family or have another child after the therapy and complete recovery.
But nevertheless, chemo- and radiotherapies remain highly toxic and can severely limit or completely wipe out fertility, so that you can no longer have children naturally.
Often, the only way to preserve your fertility is in the short window of time between diagnosis and the start of cancer therapy. Be sure to speak openly to your oncologist about whether the planned therapy may have negative consequences for your family planning or ask for a consultation at a specialised centre.
Forms of cancer therapy
Chemotherapy, radiotherapy and surgery
The treatment of cancer is physically and mentally exhausting. The therapy is only supposed to destroy the cancer cells, but unfortunately the drugs also attack the healthy organs and cells. In some diseases, the affected organs have to be partially or completely removed (ovaries or testicles).
Chemotherapy
Whether a woman can still have children after chemotherapy depends largely on three factors:
- The drug she receives
- The dose of the drug
- Your age at the start of therapy
In men, the ability to conceive is affected by the drug and the dose. Unlike a woman’s eggs, sperm can be “newly” formed while a few stem cells are still present. Sperm production can then recover, if necessary, after completion of the therapy. However, this can take many months or even years. A semen sample can be taken to determine whether and to what extent the sperm are recovering. However, if all the stem cells have been destroyed by the treatment, the body cannot produce new sperm. The man can then no longer father children.
Radiotherapy
Radiation therapy can also reduce fertility in women and men, depending on the radiation dose and the number of sessions needed.
Surgery
Some cancers require the surgical removal of the affected organ. If only one ovary is removed from a woman, the woman will usually retain her monthly menstrual period and can become pregnant through the function of the remaining ovary. If both ovaries are removed, the woman can no longer get pregnant naturally.
If the uterus has to be removed, these women can no longer be offered fertility therapy in Germany, as surrogacy is not allowed in Germany.
In men with testicular cancer, usually only one testicle is diseased, which is then removed. The remaining testicle can usually preserve the ability to conceive.
Fertility preservation options
Freezing of eggs (fertilised and unfertilised)
If irreversible damage to the germ cells cannot be ruled out after the chemotherapy used on you, freezing eggs/oval tissue may be an option for fulfilling your future wish to have a child.
Fertilised eggs
If the planned oncological treatment still allows time and there is already the right partner, eggs obtained by means of an IVF cycle can be fertilised and stored at -196°C for an indefinite period (so-called pronuclei).
Unfertilised eggs
If the right partner is not yet available, a larger number of oocytes can be obtained by means of hormonal stimulation (link Methods of egg collection) and frozen as unfertilised oocytes by vitrification.
We explain the methods of egg retrieval here.
Ovarian tissue retrieval and retransplantation after recovery
If, in rare cases, chemotherapy has to start immediately, ovarian tissue containing immature eggs can be surgically removed and frozen.
After completion of the cancer therapy, this tissue can be transplanted back into your body. The tissue then produces eggs again for a certain period of time. The procedure is now well established and is used regularly in routine practice.
However, this method, although some healthy children have already been born after it, has limitations, because theoretically there is a risk that there are metastases from the tumour in these cells of the ovary, which could then transfer back into your body and grow. Therefore, not all tumour types are suitable for ovarian transplantation.
Radiation
Before radiotherapy to the pelvis, the woman’s ovaries can be surgically moved out of the radiation field to protect the eggs they contain.
For men it is usually much easier
Men can have sperm or testicular tissue containing sperm frozen.
Sperm freezing takes very little time. You can even give a sperm sample on the day you are due to start cancer treatment.
If you can no longer ejaculate because of your illness, you cannot donate a sperm sample. In this case, testicular tissue can be removed and frozen. This tissue contains fertilisable sperm that can be used for later treatment.
Cost coverage
The coverage of costs for cancer has finally been decided! On 16 July 2020, the Joint Federal Committee (G-BA) decided that the cryopreservation of egg and sperm cells and the associated medical measures will in future be covered by statutory health insurance (SHI) under certain conditions. In the treatment of diseases, therapies may be used that pose the risk of impairing fertility or leading to its loss. With the new guideline on cryopreservation, the Federal Joint Committee (G-BA) has specified the entitlement of SHI-insured persons to the service of cryopreservation of germ cells for subsequent fertility treatment.
Cryopreservation and the associated medical measures are intended to open up the possibility for patients to fulfil their wish to have a child at a later date through artificial insemination, even after germ cell-damaging therapy. (See press release of the G-BA “Cryopreservation of egg and sperm cells as a GKV service – G-BA decides on guideline” / “Kryokonservierung von Ei- und Samenzellen als GKV-Leistung – G-BA beschließt Richtlinie” of 16.7.2020)
As of today’s date (15.9.2020), we are still waiting for the implementation. For all patients who unfortunately start fertility preservation now due to cancer, a transitional rule applies. We will be happy to advise you.
If you have been diagnosed with cancer, please email us. In these circumstances we will enable you to make an appointment IMMEDIATELY.
Alternatives to fertility preservation
Cancer therapy is physically and psychologically exhausting. After completing the therapy, take your time and also consider alternatives, e.g. adoption or foster parenthood. You can get reputable addresses from the youth welfare offices in your city.
Maybe the decision for a fertility-preserving measure is difficult for you in this situation, but try to think about it calmly anyway.
Of course, this information text cannot replace a personal conversation. You probably still have many questions. Please do not hesitate to contact us with your fears. With a note about your situation, we will immediately give you an appointment for a conversation.
Further information
