Reproductive health care in female cancer patients

The article was professionally consulted by Specialist Doctor II Phung Thi Phuong Chi - Oncology Center - Vinmec Central Park International General Hospital.

The main methods of cancer treatment today are chemotherapy, radiation therapy, surgery, endocrine therapy and targeted therapy, etc. So how does cancer treatment affect fertility? are not? Let's find out in the article below!

When a girl is born, the ovaries already contain a large number of eggs and this decreases with age. By the time of menopause, there are very few eggs left. During each month from puberty to menopause, the ovaries release an egg. To get pregnant, the egg must be fertilized with a sperm. If the egg is not fertilized, the menstrual cycle will occur. The egg released from the ovary travels along the fallopian tube and is fertilized with sperm. After fertilization, the sperm and egg will combine to form an embryo and gradually move to the uterus to implant there. Finally, the embryo gradually develops to form a fetus.
In the mid-40s to mid-50s, women experience changes in hormone levels that stop the release of eggs and stop menstruating. This is called menopause.
Some cancer treatments can also affect the ovaries and cause early menopause.

Before starting cancer treatment, if you have any questions about the effects of your treatment on fertility, ask your doctor for advice. Your doctor usually can't predict what might happen to you, but will be able to answer your concerns. Your doctor can help you by making other options that may help. If possible, you should bring your husband or boyfriend with you in these situations.
The main methods to treat cancer today are chemotherapy, radiation therapy, surgery, endocrine therapy and targeted therapy. These methods are used in combination to treat different types of cancer and can also affect fertility due to:
Effects on eggs and ovaries. Affects hormone production. Change or remove the uterus. In some cases, it's a good idea to see an obstetrician-gynecologist prior to cancer treatment to discuss future pregnancies (preserving fertility). In some cases, however, preserving fertility is virtually impossible. One of those situations is when you need immediate cancer treatment (emergency chemotherapy, emergency surgery, ...) or because the cancer itself affects fertility.
After cancer treatment, if you intend to have children but have not been able to conceive for 6 months, you should check your fertility.

Cancer chemotherapy can affect the quality of your sex life and fertility. Side effects such as fatigue, exhaustion, anxiety, or nausea and vomiting can also interfere with sex. However, chemotherapy usually doesn't have long-term effects on your sex life, and the side effects usually go away after you finish your cancer treatment.
Usually, you don't need to stop having sex during chemotherapy. However, if you have thrombocytopenia or leukopenia, you should temporarily not have sex until your blood test results improve.
Chemicals can cause abnormalities on the development of the fetus; Therefore, you need to use birth control during treatment until a few months after chemotherapy. You should also not breastfeed your baby during this time.
In addition, you should use a condom during sex during chemotherapy days as well as until a few days after finishing chemotherapy to protect your husband or boyfriend because chemicals can appear in your vaginal discharge.

Chemotherapy can affect the ovaries by reducing the release of eggs and causing temporary or permanent effects on fertility. During chemotherapy, your periods may also become irregular or stop for a while and in some cases last up to 2 years. Occasionally, chemotherapy can also cause early menopause.
The risk of infertility often depends on:
Age: The chances of getting pregnant after 35 years of age in women will be lower than in younger women because the number and quality of eggs begin to decrease and menopause is easier. In young women, after chemotherapy, if menstruation is restored, menopause will also occur 5 to 10 years earlier than usual. Chemotherapy drugs: Some chemotherapy drugs, such as cyclophosphamide and chlorambucil, have a higher risk of infertility than others, such as doxorubicin and cisplatin (moderate risk) or vincristine and methotrexate (risk) low or no risk of infertility). Dosage: The higher the dose of chemotherapy drugs, the greater the effect on fertility.

Radiation therapy is a cancer treatment that uses high-energy radiation to destroy cancer cells.
Radiation therapy to the pelvis: Radiotherapy directly to the uterus or ovaries will cause permanent infertility. Radiation therapy to the pelvis can also cause indirect damage to the uterus or ovaries and increase the risk of infertility, miscarriage, or premature birth if the lining of the uterus is damaged.
The risk of infertility also depends on the dose of radiation and your age. The older you are, the higher your risk of infertility. The risk of infertility is higher if you have recently received a combination of radiation and chemotherapy.
Whole-body radiation: Whole-body radiation is often used before a stem cell or bone marrow transplant. This method often causes permanent infertility.
Radiation therapy to the brain: Radiation therapy to the pituitary gland of the brain can have an effect on fertility because the pituitary gland releases the hormone gonadotrophin to cause the ovaries to produce estrogen and progesterone. If the pituitary gland is affected, the ovaries will not be stimulated to secrete sex hormones and cause infertility. In this case, you may be given an injection of gonadotropin to help you potentially get pregnant.
Radiation therapy to other areas of the body will not usually cause infertility.

Surgery to remove the uterus, ovaries, or pituitary gland can also affect fertility.

Endocrine therapy (also called hormone therapy) lowers the amount of hormones in the body and may have effects on fertility. Common hormonal medications are tamoxifen and goserelin (Zoladex®). Zoladex will cause amenorrhea but is usually reversible after 6 months of discontinuation. Tamoxifen can also cause irregularities in the menstrual cycle or amenorrhea, but is usually reversible within a few months of stopping the drug. However, tamoxifen can also increase the likelihood of pregnancy, so appropriate contraception should be used while using tamoxifen to avoid the risk of an abnormal pregnancy. Tamoxifen is usually used for 5 years; Therefore, if you are planning to become pregnant soon, you need to consider whether or not you should use tamoxifen after consulting with your doctor.
Targeted therapy may also have effects on fertility, but the mechanism is unknown. Of these, only one drug, bevacizumab (Avastin®), is known to increase infertility.