As a newlywed, starting chemotherapy was not part of Gina Shaw’s plans for her first wedding anniversary. Yet that’s exactly what she did after being diagnosed with breast cancer two weeks shy of her 37th birthday in 2004.
“We were married for less than a year and just started trying to get pregnant,” says Shaw, a Montclair, New Jersey, medical writer and author of Having Children After Cancer (Celestial Arts). An active woman and avid runner with no family history of breast malignancy, Shaw was blindsided by the diagnosis.
For young men and women, cancer treatments can sometimes mean the end of fertility. Although some treatments are worse than others, chemotherapy creates the biggest fertility issues, says Shaw. “It destroys fast-moving cells such as ovarian cells,” she notes.
To make matters worse, people must often address fertility issues at a time when the immediacy of beginning treatment can take precedence, which can make it more difficult to decide on how to proceed.
“Finding a doctor who can explain your fertility options is most important,” says Shaw. One study in the journal Cancer found that only 6% to 10% of women aged 18 to 40 took steps to preserve fertility after a cancer diagnosis.
In some cases, such as a late-stage diagnosis, it may be necessary to begin cancer treatment immediately and forgo fertility planning. Cancer in people under 45 tends to be faster-moving than in older adults, says Shaw.
“The cancer itself may be more aggressive and may require more aggressive therapies.” Doctors also try to buy more time for younger people; someone in their 30s with cancer has more years ahead of them than a person in their 70s and 80s, Shaw explains.
How Treatment Affects Fertility
The psychological challenge is the biggest, according to Carolyn Dean, MD, ND, co-author of The Complete Natural Guide to Women’s Health (Robert Rose). “Women are likely told they can’t have children after chemo. While it’s true that chemo can throw women into early menopause, which shuts down the ovaries, it’s not true for all cancers and all therapies,” says Dean.
Certain chemotherapy drugs known as alkylating agents (such as Cytoxan) are more likely to create infertility than others. Some medications may trigger early menopause, known as chemopause, which may or may not be temporary. Radiation treatments focused on the pelvic area, abdomen or whole body can damage a woman’s eggs, making it difficult to carry a baby to full term.
Women are born with a finite number of eggs. But men continuously produce new sperm, so chemo generally can’t kill off all of them. However, radiation for reproductive-tract cancers, including that of the prostate, can harm a man’s fertility. The American Cancer Society suggests shielding the testicles or banking sperm before treatment begins.
“Chemotherapy puts tremendous stress on your liver,” says Dean. “Plus, the immune system gets overloaded as the lymph system tries to rid itself of the chemicals.” Natural therapies based on fresh juices can help in this regard by detoxing the body and rejuvenate the liver and the immune system, says Dean.
Factors Influencing Fertility
The good news is that unless a woman has had her uterus and/or ovaries removed, administration of even the most toxic chemotherapy drugs does not necessarily eliminate the chances of her conceiving a child. Just as hair grows back, reproductive abilities may also return.
If time allows, women may be given the option of having their eggs or embryos frozen prior to cancer treatments so they can try and conceive after the treatments end. Shaw declined these options. “I’d had enough medical procedures already and still had to deal with chemo. I just wanted to get going (with the treatments),” she says.
Age is another major factor in a woman’s being able to conceive after undergoing cancer treatment. As in healthy women, conception rates diminish with age. Peak fertility occurs in a woman’s early 20s and drops off after age 35. At age 37, Shaw was told by her doctor she had a “50-50” chance of coming out of chemopause within a few months after the treatment ends. “We assumed we’d have to adopt,” she says.
The ability to conceive also varies with a woman’s hormone levels, says Wendy Vitek, MD, of the Center for Reproduction and Infertility at Women & Infants Hospital of Rhode Island. “Often a woman who had regular cycles prior to cancer treatments has a better chance of becoming pregnant,” she notes.
While diet and exercise on their own cannot restore ovarian function, a healthy lifestyle can support both fertility and overall health in both genders. For instance, scientists have found that a diet rich in fish, vegetables, legumes, whole grains and fresh fruit can improve semen quality.
As to mind-body therapies, Vitek says, “Studies remain mixed as to a direct link between practices such as yoga or acupuncture and fertility. However, integrative approaches such as these may help fertility by reducing stress.” Excess stress can alter hormone levels, thereby changing the timing of the egg’s release.
After Shaw finished her cancer treatments, she and her husband signed up with an agency and adopted a baby girl in 2006. “We didn’t think I could get pregnant after cancer,” she says.
When she and her husband wanted more children, they discovered the adoption agency had closed. So they decided to try on their own. Shaw assumed she’d be a high risk for pregnancy. “To my surprise, my oncologist did not prescribe any special limitations,” Shaw says. (This may not be the same for every woman.) She became pregnant with her son within the first month and later conceived her daughter.
Shaw tells other women trying to conceive after cancer: “If you want to be a parent, it can happen. You’ve already beaten something, so you can do this.”