Does cervical cancer treatments automatically lead to infertility?

Posted in cervical cancer; Tagged cervical cancer; Posted 15 months ago by Andreas Obermair

Whether cervical cancer treatment impacts fertility varies depending on the stage of cancer and the type of treatment required.

Not all cervical cancer treatments lead to infertility, but some can prevent a woman's ability to conceive and carry a pregnancy.

Stage 1 cervical cancer is limited to the cervix and can often be treated with surgery alone, whereas larger tumours or those extending beyond the cervix (stage 2 or higher) require a combination of radiotherapy with chemotherapy. Here, I provide an overview of how different treatments may affect fertility.

Surgical treatment options:

Cone Biopsy: This procedure involves the removal of a small part of the cervix and is an option for very small tumours. The procedure may not significantly affect fertility in most cases, although there is a slight risk of cervical incompetence (weakening of the cervix) during pregnancy, which can lead to preterm birth. In most cases, this would have no impact on the development of the baby.

Radical trachelectomy: A radical trachelectomy involves removal of the cervix and the tissue next to the cervix (parametria). This procedure is mostly done in combination with a removal of pelvic lymph nodes. It can only be performed for tumours less than 3 cm in largest diameter. It preserves the uterus for fertility reasons, allowing women to still carry a pregnancy. Pregnancy after a radical trachelectomy can put women at higher risk of having a miscarriage and having the baby prematurely. The baby must be born by caesarean section. The ovaries will be preserved.

Radical Hysterectomy: This operation is similar to a radical trachelectomy, except we use it in women who do not desire fertility any longer. It involves the removal of the cervix and uterus, making it impossible to carry a pregnancy.  The ovaries, which produce the hormones can be removed or preserved, depending on individual patient factors, including the patient's age.

Radiation and Chemotherapy:

Having (chemo-)radiotherapy to treat cervical cancer will affect both, the ovaries and uterus. This means it is not possible to become or carry a pregnancy afterwards.

In some cases, if radiotherapy is required, but the ovaries do not need to be treated, it is possible for one or both of the ovaries to be temporarily moved higher into the abdomen, so they are not exposed to the radiation treatment, then moved back afterwards. This is a surgical procedure called ovarian transposition, and it may help to keep from harmful radiation during treatment.

Chemotherapy drugs can affect fertility by potentially causing damage to the eggs in the ovaries. The impact on fertility depends on the specific drugs used, their dosage as well as individual patient factors. Sometimes we can run an IVF cycle prior to commencing chemoradiation treatment to preserve eggs (oocytes) or embryos that can be frozen and used as donor eggs.

Summary

If the cancer is early stage, cone biopsy and radical trachelectomy are surgical options that preserve fertility. Women diagnosed with cervical cancer can discuss fertility preservation options with their healthcare team before starting a treatment plan. I will always refer any patient who is keen on fertility preservation to a couple of fertility specialists I work closely with. Fertility preservation procedures, such as egg freezing, may be considered to maximise the chances of having biological children in the future.

Losing fertility can be challenging to deal with if you planned to become pregnant in the future. Even if you were not planning to have any children, the loss of your fertility can be overwhelming. Speaking to a psychologist about your feelings and individual situation will be helpful.

Fertility-preserving treatment are also available for patients diagnosed with endometrial and ovarian cancer.

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