A diagnosis of cervical cancer can bring about a wide range of emotions and questions. Because many of the treatments for cervical cancer can have a permanent impact on the reproductive system, people with this diagnosis often express concern about fertility and the ability to carry children after treatment has ended. For women who may want to have children in the future, it is important to learn about potential reproductive side effects of treatment, communicate your concerns with your medical team and seek emotional and practical support.
How Can Treatment for Cervical Cancer Impact Fertility?
Learning about potential treatment options can help you better advocate for yourself and make choices about any fertility preservation options that may be available to you. If you have questions about your specific treatment plan, speak to your medical team. They will be able to best provide answers based on your specific case.
Treatment for cervical cancer usually involves surgery, and may also include chemotherapy and/or radiation depending on the stage of the cancer and the size of the tumor. Surgery to treat cervical cancer may include a hysterectomy (the removal of the uterus and potentially other reproductive organs), after which a woman would not be able to become pregnant. For some women with earlier stage cervical cancer, a procedure called a radical trachelectomy may be an option: this surgery removes the cervix but leaves the uterus, potentially enabling a woman to have a pregnancy and deliver the baby via caesarean section.
If a fertility-sparing surgery is an option, it is important to note that chemotherapy and radiation may also impact the chances of becoming pregnant. Some chemotherapy drugs can damage the eggs within a woman’s ovaries, which can lead to reduced fertility or infertility. Additionally, chemotherapy can cause changes to a woman’s menstrual cycle, which may remain impacted even after chemotherapy has concluded. Radiation to the pelvis can often cause damage to the ovaries and uterus.
For these reasons, some women opt to explore egg or embryo freezing prior to beginning treatment, in the hopes of later utilizing their own eggs or embryos to carry a child themselves or via another woman who carries the pregnancy for them (called a gestational surrogate).
Managing the Practical and Emotional Effects of Fertility Concerns
Thinking about your future family-building wishes in the midst of a cancer diagnosis and treatment can understandably feel overwhelming. Without being able to know the exact impact that the treatment will have on your body, or how successful the fertility preservation procedures you may undergo will be, it may feel difficult to make decisions. The following suggestions may be helpful as you think about reproductive concerns following a cervical cancer diagnosis:
- If you think you may want to have children in the future, you should discuss this desire with your medical team as soon as possible and make them aware it is important to you. If your medical team does not bring up the impact of treatment on fertility, do not hesitate to initiate the discussion yourself. Although not every woman will be a candidate for fertility-sparing treatment options, having all the information about what may or may not be applicable to you can help ensure you do not miss the opportunity to explore an option if it is available to you. Your doctor will need to advise you on which fertility preservation options may be safe to explore, keeping in mind that some options will likely require a delay of the cancer treatment so that they can be performed.
- Gather information about what type of coverage or benefits your medical insurance may provide for fertility preservation. Fertility preservation procedures can be costly, and unfortunately, they are not typically fully covered by insurance. Getting a sense of what costs you may be responsible for can further assist you in making decisions. Explore resources that may be able to help with the out-of-pocket costs, such as LIVESTRONG Fertility, Verna’s Purse (ReproTech), Fertile Action and The SamFund.
- Enlist emotional and practical support from trusted family members, friends, or counseling professionals such as an oncology social worker or therapist. CancerCare offers free short-term supportive counseling with oncology social workers over the telephone nationally and face-to-face in our New York City area. The American Psychosocial Oncology Society (APOS) can help connect you to counseling professionals in your area who have special expertise in working with individuals and families impacted by cancer.
- Many women find it helpful to connect with other women who have gone through similar treatments and experiences. Connecting with a cervical cancer survivor can provide an opportunity to discuss shared challenges and talk through decisions with someone who has “been there.” If you’d like to talk one-on-one with a survivor via telephone, you can arrange for a “peer match” through organizations such as Cancer Hope Network or Imerman Angels. CancerCare offers a free, private online gynecological cancer support group moderated by an oncology social worker, which can provide a space for discussion and connections with other women undergoing treatment.
Making fertility-preservation decisions at a time when you are likely also coping with many challenging emotions and under a time-constraint can feel daunting. Know that there are not right or wrong answers about how to proceed, how you may elect to preserve your fertility, or how you may build your family in the future.
Stacy Chilton, LMSW, is the Women’s Cancers Program Coordinator at CancerCare. She oversees CancerCare’s Women’s Cancers Program, as well as provides counseling to people coping with cancer and people who have experienced the loss of a loved one.