Cancer and its treatment can affect fertility in both men and women, depending on several factors, such as the type of drugs used, the dose, the duration of treatment, the age and previous health status of the person.
The patients with the highest risk of infertility are those receiving some types of chemotherapy, hematopoietic progenitor transplantation or radiotherapy.
In the case of chemotherapy administration, the treatment can alter hormone levels, induce early menopause in women, permanently affect sperm production, damage nerves or cause certain sexual organs to stop functioning properly. Fertility preservation should always be discussed with the young cancer patient before beginning treatments.
How does chemotherapy affect fertility
Chemotherapy drugs can damage ovarian follicles in women and sperm cells in men, which can lead to decreased fertility or permanent infertility. Also, the effects can vary depending on several factors, such as the type of drugs used, the dose and duration of treatment, as well as the age of the patient.
Impact on female fertility
- Ovarian reserve. Chemotherapy treatments can damage the eggs in the ovaries, reducing the quantity and quality of eggs available for fertilization. This can lead to temporary or permanent infertility.
- Early menopause. In some cases, chemotherapy can induce early menopause.
Impact on male fertility
Chemotherapy can damage sperm-producing cells in the testes, which reduces sperm quantity and quality, affecting fertility.
- Reduced or no sperm production. In some cases, sperm production may decrease significantly or stop temporarily or permanently.
- Genetic mutations. Chemotherapy drugs can increase the risk of mutations in sperm, which can affect fertility or increase the risk of congenital malformations.
Chemotherapy treatments and fertility
Although predicting the risk of infertility in a patient is very complicated, some chemotherapies present a higher risk profile for fertility than others. This is because different drugs have different mechanisms of action and levels of toxicity to reproductive cells.
Alkylating agents
Alkylating agents are known for their ability to damage rapidly dividing cells, such as ovarian and sperm precursor cells. In women, these drugs can severely affect ovarian reserve, reducing both the number and quality of eggs. In men, they have a high potential to damage sperm stem cells, breaking the DNA strands and causing a drastic decrease, or even total cessation, of sperm production. The damage caused by these agents is cumulative, so higher doses or prolonged treatments increase the risk of permanent infertility.
Platinum analogues
Platinum analogues can also affect male and female fertility, although their risk of causing permanent infertility is lower compared to alkylating agents. However, in combined treatments, their effect may be intensified.
Antimetabolites and antitumor antibiotics
Antimetabolites and antitumor antibiotics tend to have a less severe effect on female fertility compared to alkylating agents and platinum analogues. In men, although their impact on sperm production may be less severe, in combination with other more toxic agents, they may contribute significantly to the reduction in sperm count.
Factors influencing the impact
Different types of tumors and cancer chemotherapies may have different effects. However, the risk of infertility varies depending on:
- Age of the patient. Young women have a greater chance of recovering ovarian function after treatment because they have a larger and healthier ovarian reserve. Similarly, young men have a greater chance of recovering sperm production after treatment due to the greater regenerative capacity of their spermatogonial stem cells. As people age, fertility recovery becomes more difficult.
- Cumulative dose and duration of treatment. In both men and women, lower doses and shorter treatments tend to cause less harm. However, some medications have cumulative effects that can be devastating to ovarian function.
Fertility recovery after cancer
Recovery in women
After chemotherapy, some women may experience a resumption of the menstrual cycle within a few months, while others may take longer or not resume at all. Resumption of the menstrual cycle is a good indicator of recovery of ovarian function.
However, women who have received chemotherapy or radiation to the pelvis are also at risk for sudden and early menopause even after they start having menstrual cycles again. Menopause may begin 5 to 20 years earlier than expected.
Recovery in men
In the case of male fertility, sperm production slows down or stops completely after chemotherapy treatment. In this regard, fertility recovery may vary. Some men may recover sperm production within one to four years after treatment, but in other cases, infertility may be permanent.
It is important to regularly monitor testicular function through semen analysis and consultation with a fertility specialist. This helps to assess recovery and plan possible fertility treatments if necessary.
Fertility preservation
Before starting chemotherapy treatment, it is important for the medical team to explain fertility preservation options to the patient and plan the best approach on a case-by-case basis.
For women
- Oocyte vitrification. This process involves the rapid freezing of eggs for future use.
- Embryo cryopreservation. Similar to oocyte vitrification, but in this case already fertilized embryos are frozen.
- Ovarian tissue freezing. Ovarian tissue is removed and frozen, which can be reimplanted after treatment.
- Ovarian suppression. Use of drugs to protect the ovaries during chemotherapy.
For men
- Sperm cryopreservation. Freezing of semen samples before starting treatment.
- Cryopreservation of testicular tissue. In cases where it is not possible to obtain semen, testicular tissue can be frozen for future use.
In summary, chemotherapy can significantly affect fertility in both men and women, depending on the type of drugs, the dose, the duration of treatment and the age of the patient. It is crucial to discuss fertility preservation options with the medical team before starting treatment, as there are several techniques available to maintain the possibility of having children in the future.
At IVOQA we have a multidisciplinary team. Before starting any treatment, fertility and future gestational desire is discussed by our team in order to take the appropriate measures for future parenthood.
Viamed also has the Viamed Fertility Institute, which specializes in assisted reproduction treatments, including in vitro fertilization (IVF), artificial insemination, fertility preservation and advanced techniques such as preimplantation genetic testing.
If you are concerned about how chemotherapy might affect your fertility or want to learn about fertility preservation options, do not hesitate to contact the Viamed Institute of Advanced Surgical Oncology (IVOQA). Our multidisciplinary team is prepared to offer you personalized advice, taking into account your particular situation and your wishes for future parenthood.
