How Cancer Treatment Can Affect Fertility
- A young woman from England hoping to start a family and become a mother has been dealt a devastating medical blow: an ovarian cancer diagnosis.
- When Charlotte Badescu, 31, was struggling to conceive, she visited her doctor. Tests revealed a 16-centimeter tumor in her pelvis. She was told it was 90% cancerous and she needed major surgery as a result.
- Charlotte was diagnosed with granulosa cell tumor of the ovary, which causes higher than normal levels of estrogen in a woman’s body. She’s now successfully undergone cancer surgery and is, with her husband, having fertility treatments.
- A common treatment for ovarian cancer is chemotherapy, and some types of chemo can destroy eggs in a woman’s ovaries. This can make it impossible or difficult to get pregnant later on. Whether or not chemotherapy makes you infertile depends on the type of drug and the woman’s age, since egg supply decreases with age.
Charlotte Badescu, 31, from Merseyside, England, was excited to start a family with her new husband, John, but last year, she was “struggling” to conceive, she told the Liverpool Echo, a newspaper near her home in Mossley Hill, a suburb of Liverpool in Merseyside.Read More
“I had (the surgery at) the start of December and had my right ovary and fallopian tube removed,” she told the Echo. “Tests on that showed I had a rare ovarian cancer — granulosa cell tumor, which accounts for about 2 percent of ovarian cancers.”
Granulosa cell tumors of the ovary cause higher than normal levels of estrogen in a woman’s body, according to the National Institutes of Health. Treatment consists of surgery to remove the tumor (like Charlotte), and additional treatments may also be used depending on the extent of the tumor.
Charlotte’s surgery was a success, but she told the newspaper that she and her husband are now in a “waiting game” — they’re going through fertility treatment in order to start a family following Charlotte’s ovarian cancer diagnosis.
She’s sharing her story now in hopes of inspiring others to advocate for their own health.
“I didn’t have periods for three months after the wedding, which was abnormal,” she said. “If you have a change in your periods or your tummy doesn’t feel right, see your GP. If I hadn’t seen my GP when I did, it would’ve been different. I was fortunate but I had vague (ovarian cancer) symptoms.”
“You know your own body,” she added, “the GP is the best place and they are more than happy to help put your mind at rest.”
How Cancer Treatment Can Affect Fertility
It remains unclear what stage Charlotte’s ovarian cancer was at when she was diagnosed, and it hasn’t been confirmed whether she received additional treatment after surgery.
But, a common treatment for ovarian cancer is chemotherapy, and some types of chemotherapy can destroy eggs in a woman’s ovaries. This can make it impossible or difficult to get pregnant later on. Whether or not chemotherapy makes you infertile depends on the type of drug and the woman’s age, since egg supply decreases with age.
“The risk is greater the older you are,” Dr. Jaime Knopman, a board-certified reproductive endocrinologist with years of experience treating couples and individuals experiencing infertility, previously told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal,” she adds. “But, if you’re 29, your ovaries may recover because they have a higher baseline supply.”
Radiation to the pelvis can destroy eggs; it can damage the uterus, too. Surgery on a woman’s ovaries or uterus can hurt fertility, as well.
If you are having a treatment that includes infertility as a possible side effect, your doctor will not be able to tell you for sure whether you will have this side effect. That is why you should discuss your options for fertility preservation before starting treatment.
Research shows that women who have fertility preservation prior to breast cancer treatment, in particular, are more than twice as likely to give birth after treatment than those who do not take fertility-preserving measures, such as freezing eggs or embryos.
When freezing eggs or embryos is not an option, doctors may try these less common approaches:
- Ovarian tissue freezing, an experimental approach for girls who have not yet reached puberty and do not have mature eggs, or for women who must begin treatment right away and do not have time to harvest eggs.
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
Ovarian Cancer Treatment: Chemotherapy & Surgery
Doctors have two main approaches to treatment when they are working with ovarian cancer patients, and both methods offer patients a combination of chemotherapy and surgery, according to Dr. Jose Alejandro Rauh-Hain, a gynecologic oncologist at MD Anderson Cancer Center.
“Both groups (of women) get chemotherapy and surgery,” he explained during a previous interview with SurvivorNet, “it’s just the sequence of how we do it.”
If a doctor is confident they can remove the ovarian tumor completely without initial cycles of chemotherapy, the doctor will go ahead with a surgical procedure.
The group that receives surgery first still goes through chemotherapy following the operation to ensure that the cancerous tissue is fully excised. This process is known as adjuvant chemotherapy, or a therapy given after initial treatment to ensure effectiveness.
The other group is made up of women whom doctors are not confident they can perform successful surgical tumor removal. This group receives chemotherapy before surgery; this group usually receives a final chemotherapeutic treatment after surgery as further assurance that the cancerous tissue is gone.
This necessary combination of both treatments is related in part to the particular virulence of ovarian tumors. The cancer is particularly difficult to detect, so the average woman has a sizable tumor once she is diagnosed. Because of this, both chemotherapy and surgery are needed to remove the cancer.
Contributing: Chris Spargo & SurvivorNet staff reports