Biologic Surprises: Pregnancy After Cancer

CURE, Summer 2014, Volume 13, Issue 2

Nature can still spring some surprises—even when the toxic effects of cancer treatments have seemingly closed the fertility door for some men and women.

Fertility preservation, such as storing frozen sperm or embryos, remains the best way to maximize a cancer patient’s chance of conceiving after treatment, says Mitchell Rosen, a reproductive endocrinologist who directs the fertility preservation program at the University of California, San Francisco. But some patients may not have that option due to the urgent time frame to tackle the cancer. Also, insurance coverage for fertility preservation can be complicated by varying state laws and other provisions.

Chemotherapy can damage a woman’s eggs, Rosen says. In some cases, a woman’s menstrual cycle shuts down permanently. A study Rosen was involved in, that published in 2012 in the journal Cancer, found that 3 to 10 percent of 620 women experienced acute ovarian failure after chemotherapy for malignancies including leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, breast and gastrointestinal cancers.

Some women initially feel as though they are in menopause, including enduring hot flashes, but then their menstrual cycle returns. Citing a 2013 study in the Journal of Cancer Therapeutics & Research, Rosen says that the majority of women experience a return of the menstrual cycle within a year, but in 9 percent of cases, the cycle comes back after a year.

Since some eggs might have been damaged by treatment, female patients might be advised to wait a year before trying to get pregnant, Rosen says. Those women also may face a time crunch, though, as some treatments can trigger earlier menopause—even if their menstrual cycle returns for a stretch.

Men worried about their fertility can get a sperm count. In women, tests can quantify remaining eggs. Above all, speed is of the essence, and Rosen’s own study shows that women can become pregnant despite drug toxicities.

Overall, 19 percent of the 620 women surveyed did report giving birth. Those diagnosed with Hodgkin lymphoma and gastrointestinal cancers were most likely, with 24 percent and 22 percent respectively, followed by women with non-Hodgkin lymphoma (21 percent), leukemia (17 percent) and breast cancer (9 percent).