Managing Your Fertility After Cancer Treatment

Transcription

1 Managing Your Fertility After Cancer Treatment Information for women who have finished treatment UHN You may worry about your fertility after cancer treatment. Read this handout to learn about: Cancer treatments and fertility Talking to your medical team about infertility Other options Getting support Please visit the UHN Patient Education website for more health information: University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Dr. Sarah Ferguson, Dr. Doris Howell, Stephanie Bertin and the ELLICSR Research Team Created: 05/2013 Form: D-5745

2 How do cancer treatments affect fertility? The main treatments for cancer are chemotherapy, radiotherapy, and surgery. These treatments affect fertility in different ways. There are also new treatments, including: new chemotherapy drugs biological therapy drugs (a new type of cancer treatment) We do not know exactly how these new drugs affect fertility. Ask your cancer specialist about how your treatment may affect your fertility. How does chemotherapy affect fertility? Chemotherapy affects the way your ovaries work. It can cause you to produce fewer or no eggs. Your periods may become irregular or stop for a while. This is called temporary infertility. It may take up to 2 years for your periods to come back again. Even if your periods do come back, your menopause may start 5 to 10 years earlier than usual. This is because chemotherapy can reduce the number of eggs you have and you have a shorter time than usual to try to get pregnant. Chemotherapy sometimes causes permanent infertility. It may also bring on an early menopause. The risk of infertility depends on these factors: Your age If you are less than 35 years old, you are more likely to stay fertile. Your periods usually come back. If you are over 35, you already have fewer chances of getting pregnant. Chemotherapy is more likely to make you go into menopause. Your risk of infertility is higher the older you are, and the closer you are to your natural menopause. 2

3 The type of chemotherapy drugs you had Cyclophosphamide and Chlorambucil have a higher risk of causing infertility. Doxorubicin and Cisplatin have a medium risk of causing infertility. Vincristine and Methotrexate have little or no risk of causing infertility. Paclitaxel (Taxol) and Carboplatin have a medium risk of causing infertility. The dose Higher doses of chemotherapy are more likely to affect fertility. The risk is even higher if you also had stem cell transplants. How can radiotherapy affect fertility? Radiotherapy treats cancer by using high-energy rays to destroy cancer cells. Radiotherapy to the pelvis may affect a woman s fertility. Radiotherapy to the pelvis Radiotherapy given directly to the ovaries will cause permanent infertility. Radiotherapy can also damage the uterus. This can make it harder for an embryo to implant. It can also increase the risk of miscarriage or premature birth. How can surgery affect fertility? Some operations to the pelvic area can affect fertility. These include: having your uterus removed (hysterectomy) having both ovaries removed (bilateral oophorectomy) some types of surgery to the cervix 3

4 When should I talk to my medical team about infertility? Doctors may not know exactly how your fertility will be affected. They can give you an idea of your risk based on factors like your age and the treatment you are having. In some cases, it may be possible to reduce the effects of treatment on your fertility. Some treatments may help you stay fertile. How can a fertility expert help? If you are having difficulty getting pregnant after your treatment, your doctor can refer you to a fertility clinic. The fertility specialist will tell you what options you have. What other options do I have? Some women may consider adoption or surrogacy. Surrogacy is when another woman carries a baby for you. For more information about surrogacy, see the website of The Human Fertilization and Embryology Authority (HFEA). Adoption or surrogacy are your only options to have a child if: your uterus was removed you had radiotherapy directly to the uterus Some women choose not to have fertility treatment, adoption or surrogacy. They go on to enjoy life without children. Everyone is different. How can I check my fertility if my periods come back? If your periods come back, blood tests can give you information about your fertility. Your specialist can do a blood test to measure a hormone called follicle stimulating hormone (FSH). The results of this test can help find out how many eggs you have left in your ovaries. This tells you about how close you are to menopause. This test has to happen on a certain day of the month. This is because FSH levels change during the month. 4

5 AMH (anti-mullerian hormone) is a new blood test. It may give more accurate information about your fertility and how many eggs you have left. You can take this test at any time. The level of AMH does not change during the month. Your doctor can refer you to a fertility clinic for these blood tests if: you are having trouble getting pregnant you did not have any fertility preservation before treatment Is hormone replacement therapy an option for me? Hormone replacement therapy (HRT) can help women who go into early menopause because of cancer treatment. Talk to your doctor and oncologist to see if this is an option for you. There are benefits and risks that are important to discuss. HRT is not recommended if you had breast cancer, or another type of cancer that responds to hormones. Some women s fertility comes back while they are on hormone replacement therapy (HRT). If you do not want to get pregnant, use a type of birth control that you can rely on. Some women may be able to take birth control pills instead of HRT. The pill replaces your hormones and prevents pregnancy. You can discuss this in more detail with your doctor. 5

6 How can I get support? Infertility can be very hard to live with. It may seem even harder after a long journey with cancer. You may not know if your fertility will come back or not. This can be hard to cope with too. Some women find it helpful to talk about this with their partner, family or friends. Others may prefer to talk to a counsellor. You can get support from: a counsellor arranged by your family doctor or cancer specialist specialist nurses at the hospital a counsellor at a fertility clinic Where can I get more information? Foundation for Women's Cancer (formerly the Gynecologic Cancer Foundation) National Cancer Institute American Cancer Society Fertile Future fertilefuture.ca 6