How Ovarian Cancer Can Affect Fertility

Ovarian cancer is a form of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The primary function of the ovaries is to produce eggs as well as the hormones estrogen and progesterone. Surgery and chemotherapy are generally used to treat ovarian cancer.
Ovarian cancer is the sixth most common malignancy in women and represents 4% of all cancers in females. A woman has approximately a 1.8% risk of developing ovarian cancer in her lifetime. This can be compared to a 12% lifetime risk of developing breast cancer.

Signs and symptoms of ovarian cancer may include:

  • Abdominal bloating or swelling
  • Quickly feeling full when eating
  • Weight loss
  • Discomfort in the pelvic area
  • Changes in bowel habits, such as constipation
  • A frequent need to urinate

Certain factors may increase your risk of ovarian cancer:

  • Age: Ovarian cancer can occur at any age but is most common in women ages 50 years and older
  • Obesity
  • Family history of ovarian cancer, breast cancer, or colorectal cancer
  • Estrogen hormone replacement therapy, especially with long-term use and in large doses.
  • Age when menstruation started and ended: If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher
  • Never being pregnant
  • Smoking
  • Use of an intrauterine device
  • Polycystic ovary syndrome

Tests and diagnosis

  • Your doctor will conduct a physical pelvic examination
  • You may need an ultrasound or CT scan of your abdomen and pelvic area
  • Blood tests
  • Surgery to remove tissue samples

Treatments and drugs
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Early stage ovarian cancer may involve removing the effected ovary and its fallopian tube. Advanced ovarian cancer may require removing both ovaries, the fallopian tubes, the uterus and nearby lymph nodes, and possibly abdominal tissue.

After surgery, you’ll likely be treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein or directly into the abdominal cavity or both.

How Ovarian Cancer Can Affect Fertility
Many types of cancer treatment can reduce a woman’s fertility, which is the ability to have children. Temporary or permanent infertility occurs when treatment affects the function of the reproductive endocrine system, which includes the glands and other organs that make hormones and produce eggs. Permanent infertility occurs when treatment involves removing the ovaries or uterus.

Treatment prescribed, be it surgery, chemotherapy or radiation, will determine how much damage the ovaries and reproductive organs will sustain. Delving further, the dose, type, duration, location and scope used for these methods will also affect whether or not treatment will impact fertility.

There are various techniques oncologists can use that can minimise the damage done to reproductive potential. Ovarian shielding can protect ovaries during radiation while ovarian suppression methods temporarily shut down ovaries.

After treatment, some women may retain their fertility potential. For others, menopause may arrive earlier in life, or even immediately after treatment. Taking into account, all of these factors can make it very difficult to predict whether a women’s eggs or reproductive organs will maintain function.

Having a Baby After Cancer
Having children may be the last thing on your mind following a devastating diagnosis of cancer. But with cancer, time is of the essence. Before you undergo chemotherapy, radiation or surgery, talk to a reproductive specialist about how to safeguard your fertility. If you can delay chemo or radiation for a few weeks, it may be possible to harvest eggs to freeze and store for possible future use.

Egg Freezing
Egg freezing can be roughly a 1-2 month process. However, with cancer patients the evaluation and treatment are done together to quickly freeze eggs and move on to cancer treatment immediately. First, patients must complete blood tests and ultrasounds to determine candidacy for egg freezing. Next, two weeks of medicine are taken to prepare the eggs and then an egg retrieval procedure is done. While you are on medicine, the growth of the eggs is monitored with ultrasound and blood tests to see when they will be ready. During the egg retrieval, you will be placed under light sedation and may feel a bit of cramping and bloating afterwards. The goal is to freeze somewhere around 10-15 eggs to optimise the chance of success later. Patients with hormone-sensitive breast cancer or breast cancer that has progressed may not be eligible for this form of fertility preservation.

Embryo Freezing
Should you already have a partner, this is the best option for future success. As you can imagine, eggs are extremely delicate and fragile and not all frozen eggs will survive the thawing process. You will need to undergo an egg retrieval after which your eggs will be fertilised with your partner’s sperm. The resulting embryos are frozen and can be used in the future for treatment. If carrying a baby in the future is not a possibility, a gestational carrier or surrogate is also an option.

Ovarian Tissue Freezing
While this is still an experimental procedure that is not widely available, ovarian tissue freezing is an exciting option for those looking to preserve fertility. Patients undergo a surgical procedure where part or all of an ovary is removed. The ovarian tissue containing immature eggs and hormone-producing cells is then cut into strips and cryopreserved. After a patient is cancer-free, the frozen ovarian tissue is thawed and transplanted back to the patient’s uterus. Even if this isn’t for three years, the frozen ovarian tissue will remain the same age as when it was cryopreserved.

What You Can Do
A diagnosis of cancer is devastating and making early parenthood decisions at such a time can be very difficult. It is, however, imperative to perform egg freezing prior to any chemotherapy or radiation treatment as potential damage can lead to infertility in both males and females. Cancer therapy can destroy a person’s fertility and their chances of having a family. Your risk of being infertile after cancer treatment depends on the type of treatment, your pre-treatment fertility status, and your age. Your oncologist can give you an estimate of the likelihood that your treatment will decrease your fertility.

Medfem Fertility Clinic is keeping hope alive by offering the opportunity to freeze eggs before treatment. If you are facing a medical treatment such as chemotherapy, radiation or surgery that may affect your fertility, we may be able to help you. In these circumstances, we often need to take action prior to the medical treatment. Therefore, we try to see all urgent cases within 24 hours of having received a referral from your physician.

If you or someone you know has been recently diagnosed with cancer that can impact their future fertility, call our offices immediately at +27 (11) 463 2244 to schedule a consultation.

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