Uterine cancer, ovarian cancer and cervical cancer are the most common gynaecological cancers in women affecting thousands of women, each year. Going through cancer treatment, especially cancer that affects any part of the reproductive system, can be worrying, as cancer treatments like chemo, surgery and radiotherapy can interfere with a woman’s fertility. Therefore, most women going through cancer treatment which affects the walls of the uterus (womb), the ovaries, the cervix, or the vagina, have to deal with the possibility of not being able to have children.
4It is important to talk to your doctor or specialist about the possibility infertility even before starting treatment so as to understand the risks involved and the steps to take to maintain your fertility; and if preserving fertility is impossible, depending on the stage of your cancer, the doctor can help patients to know what other options are available, especially for women of childbearing age.
The issue of preserving fertility depends on a number of factors, such as:
- A woman’s age,
- The stage of the cancer,
- The type of treatment being used,
- Whether the woman has a partner who can provide sperm, and
- Personal preference.
These factors can help determine the method you are to use to preserve your fertility. Some of the ways recommended to preserve fertility include:
1. Embryo freezing: Commonly known as IVF (In Vitro fertilisation), this method is the most common form of fertility preservation. It basically involves collecting eggs from a woman which will then be fertilised in a laboratory and frozen. Before the eggs are harvested, the woman has to take fertility drugs for about 2 weeks.
2. Unfertilised-egg freezing: Also known as Oocyte Cryopreservation, it is similar to IVF as the eggs are frozen; however, in this option, the eggs are frozen without being fertilised.
The other preservation options involve treating the cancer and preserving fertility at the same time. These methods include:
3. Progesterone therapy: Mostly used for young women with pre-cancerous changes in the cells of the uterus or for uterine cancer in its early stage, it involves using hormone progesterone. The hormone is administered using an intrauterine device or it can be given as a pill.
4. Surgery to preserve fertility: This is done in two different ways; either by removing the cervix and keeping the uterus or by removing one uterus only. Without a cervix, a woman can still get pregnant but will have to go through a C-section to give birth because the cervix is the area of the body that opens to allow for a baby to be born and when one ovary is left intact eggs will still be produced and a woman can get pregnant.
5. Ovarian tissue preservation: The ovarian tissue is removed through surgery and frozen so that, after treatment, it can be transplanted, and a woman can get pregnant. This method is, however, an option for young girls who cannot go through embryo freezing or oocyte cryopreservation.
6. Ovarian suppression: This method, on the other hand, involves taking hormones to suppress the function of the uterus which can protect the eggs from getting damaged during cancer treatment.
7. Radiation shielding: This basically means shielding organs and in this case the ovaries, from being damaged by radiation during treatment of cancer near the ovaries. Protective coverings are used to shield the ovaries from the radiation.
8. Radiation trachelectomy: When cervical cancer is in its early stage, the cervix can be removed while the ovaries and uterus are left intact. The vagina is then connected to the uterus directly. A band or stitch is then placed around the bottom part of the uterus to prevent radiation from reaching the ovaries. This tightens the opening preventing radiation from reaching the ovaries. However, menstrual blood and sperm can still pass through the opening.
9. Ovarian transposition: In the case of ovarian cancer, if a woman is receiving radiation on one ovary, then fertility is preserved in the other ovary. Surgery can also be done to protect the ovaries by removing them and implanting them where they cannot be reached by the radiation that can cause them damage. They are put back in place after the treatment.