Coping With Infertility
- “Bachelor” star and former NFL player Colton Underwood, 32, eagerly awaits the chance to experience fatherhood with his husband as he anticipates teaching their future child life lessons. While going through the process of surrogacy, he says he’s gained a great appreciation for the women involved.
- Underwood’s journey toward fatherhood hit a snag when he learned he had a low sperm count. He went public with his fertility struggles to help remove the shame and stigma surrounding this sensitive issue affecting “one in five” married couples, the Centers for Disease Control and Prevention (CDC) says.
- Fertility struggles are a fact of life for some cancer patients because certain cancer treatments, including chemotherapy and radiation, can affect both men’s and women’s fertility.
- It’s recommended that before undergoing cancer treatment, patients talk to their doctors about fertility preservation if they wish to have a family in the future.
- Egg, sperm, and embryo freezing are common approaches to fertility preservation, but other options exist.
“Bachelor” star Colton Underwood, 32, eagerly awaits fatherhood after previous struggles with infertility. He and his husband are using a surrogate to have a baby. Throughout their fertility journey, the former football star says he’s gained immense appreciation and gratitude for women undergoing the process.
“Having an appreciation of what these incredible women—both the egg donors and the surrogates—have to go through was a starting point for us,” Underwood said on his “Daddyhood” podcast, which chronicles his and his husband’s fertility journey.
Resources on Fertility and Cancer
Underwood’s Fertility Journey So Far
The World Health Organization notes that “around 17.5%” of the adult population, or roughly one in six people, globally struggle with infertility. According to the Centers for Disease Control and Prevention (CDC), infertility is “not being able to get pregnant (conceive) after one year (or longer) of unprotected sex.”
In Underwood’s case, he and his husband discovered he dealt with infertility after visiting a fertility clinic.
“I got my sperm results back, and I had four sperm. Three of them were dead. One was barely moving in my sample,” he told People Magazine.
“I was basically considered technically infertile,” he added.
Underwood attributed his low sperm count to his intense training regimen when he was younger and an athlete.
“It is hard, and it’s so intimate. I had so much shame around it. I felt inferior,” Underwood said.
Fortunately, when Underwood retested his sperm at the fertility clinic a short while later, his sperm produced better results. However, the brief period of infertility stuck with him afterward.
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Several factors for both men and women can cause infertility. In men, the shape of the sperm, sperm count (concentration), and its ability to move may all contribute to infertility. Other factors may include damaged testes, heavy alcohol use, smoking, anabolic steroids, and drug use, which are known risk factors for infertility in men. Certain medical conditions may impact a man’s fertility, including cancer treatment – more on that later.
Among women, a disruption in ovarian function may affect fertility. Known conditions that may disrupt ovarian function include polycystic ovary syndrome (PCOS), which causes women not to ovulate. Diminished ovarian reserve is a condition that causes women to have fewer eggs. Premature menopause affects women under 40, and naturally occurring menopause is the normal decline in ovarian function around 50 years old.
How Cancer Treatment Impacts Fertility
Fertility struggles are also a genuine concern among cancer patients, as certain cancer treatments can cause infertility. Fortunately, in many cases, efforts can be made before beginning treatment to help preserve fertility.
Many couples, at one point or another, experience infertility. The Centers for Disease Control and Prevention (CDC) says within the U.S., “about one in five” married women between the ages of 15 to 49 with no prior births are unable to get pregnant after trying for a year. Additionally, “one in four” of women in this group struggle to get pregnant or carry the pregnancy to term.
Infertility may affect many cancer patients undergoing treatment due to cancer treatment’s impacts on the body. Various cancer treatments, including chemotherapy and radiation, can affect both men’s and women’s fertility. Before undergoing cancer treatment, patients should speak to their doctors about fertility preservation if they wish to have a family in the future.
The American Psychological Association said in its Monitor on Psychology Magazine, “A diagnosis of infertility–the inability to get pregnant after a year or more of trying–can lead to depression, anxiety, and other psychological problems, trigger feelings of shame and failure to live up to traditional gender expectations and strain relationships, say psychologists specializing in infertility.”
Among men, infertility can “cut into a man’s feelings of masculinity” and “can lead to issues of shame and embarrassment.” psychologist William D. Petok said.
Cancer’s Impact on Male Fertility
Cancer treatments like chemotherapy can damage sperm in men, and hormone therapy can decrease sperm production, according to the National Cancer Institute. Radiation treatment can also lead to lower sperm count and testosterone levels, impacting fertility.
These possible side effects of cancer treatment should be discussed with your doctor before starting treatment. Men may have the option to store their sperm in a sperm bank before treatment to preserve their fertility.
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This sperm can then be used later as part of in vitro fertilization (IVF), a procedure in which a woman’s egg is fertilized with sperm in a lab. The embryo is then transferred to a woman’s uterus to develop.
WATCH: Dr. Terri Woodard explains fertility preservation options patients have when going through cancer treatment.
Cancer Treatment’s Impact on Fertility in Women
Just as cancer treatment can impact men’s fertility, women may also be affected. Some types of chemotherapy can destroy eggs in your ovaries. This can make it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the type of drug and your age since your egg supply decreases with age.
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you are having a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you for sure whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women who preserve their fertility before cancer treatment do so by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor who specializes in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and your eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment right away and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine treatment.
Questions for Your Doctor
If you’re wondering how your cancer treatment may affect your fertility and what options are available to you, consider asking your doctor these questions, according to the National Cancer Institute:
- Could my treatment lead to infertility?
- Are there other recommended cancer treatments that might not cause fertility problems?
- Which fertility preservation options would you advise for me?
- What fertility preservation options are available at this hospital? At a fertility clinic?
- Would you recommend a fertility specialist (such as a reproductive endocrinologist) I could talk with to learn more?
- What are the chances that my fertility will return after treatment?
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