In the past two years, COVID-19 has caused a major disruption in the healthcare system and stands to be a matter of concern for oncology services in India. According to a recent study, India could witness 98,650-1,31,500 excess cancer-related deaths in the next five years. As the number of cancer cases rise, people are also concerned about the impact of cancer on their fertility. However, it is important to understand how it is possible to fulfil your dreams of becoming parents even after being diagnosed with Cancer.

Cancer and fertility

Cancer treatments may affect your fertility in many ways. The uterus and ovaries are highly vulnerable to disruptions caused by surgery, chemotherapy, and radiotherapy. Also, treatment modalities for gynaecological cancers can have an anatomical or functional impact on a woman's reproductive organs. Furthermore, cancer treatment is often a lengthy process that impairs patients' sexual function and mental health. Mental conditions such as anxiety, depression, and diminished quality of life are important aspects of ongoing and post treatment symptoms that directly influences their fertility as well. The fact that cancer treatment can lead to infertility is another potential distress for cancer survivors.

Infertility in cancer patients can occur for a variety of reasons. The patient's age and developmental stage, such as before or after puberty, before or after menopause, and so on, can influence whether or not conceiving is possible. Similarly, the type and extent of surgery, the type of treatment (radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, stem cell transplant), and the treatment dose can all affect the fertility of both men and women undergoing cancer treatment.

Treatments like Chemotherapy and radiation treatment for cancer have been said to cause damage to the testes and interfere with sperm production and testosterone secretion in men, as well as damage oocytes (eggs), cause ovarian failure and early menopause in women.

Natural conception after cancer

Women who were fertile before treatment may experience a natural recovery post completing the cancer treatment. They are capable of maintaining or restoring normal hormonal cycles, and producing mature eggs that can be fertilised and implanted into the uterus, resulting in conceiving naturally. Before attempting to conceive, the doctors usually advise waiting anywhere between 6 months to 24 months. Waiting for six months may reduce the risk of birth defects that can be caused by the eggs damaged by chemotherapy or other treatments. The 24 months period is based on the fact that the risk of cancer recurrence is usually highest in the first two years following treatment.

While for men, there are no hard and fast rules as to how long they should wait after cancer treatment, however most doctors recommend waiting two to five years. Chemotherapy and radiation therapy can harm sperm, and thus the two precautionary years help in replacing the sperm. As a result, conception becomes easy.

Prevention is always better than cure: Freezing the eggs before cancer treatment

The number of young women with cancer who choose to freeze their eggs before starting cancer treatment is on the rise, thanks to increased awareness. Seeds of Innocence has seen a 15 per cent increase in the number of female cancer patients under the age of 35 who have chosen to freeze their eggs in the last year. Also, in the past few years we have also witnessed many successful cases where the decision of freezing the eggs or freezing the sperm before the cancer treatment has worked as a boon for the couple. Regardless of marriage, egg/sperm freezing is a reliable option. The eggs can be frozen for up to ten years, during which time she can have them thawed and fertilised whenever she wants. It's best if you talk about preserving your fertility before you have cancer surgery or start treatment.

If infertility develops as a result of cancer, consider IVF

In case of completing the cancer treatment, IVF is a safe method to become pregnant for cancer survivors. In vitro fertilisation is effective in women who have lost their fertility as a result of cancer treatment. Whereas, Donor eggs are an option for women who are unable to conceive with their own eggs. In this technique, embryos are transferred to the recipient to create a pregnancy. This process is supplemented with hormone replacement therapy until the placenta develops and can produce its hormones.

Cryopreservation can help in conceiving soon after the cancer treatment and one does not have to wait for years to get pregnant safely.

The writer is Dr Gauri Agarwal, Founder & Director at Seeds of Innocence and Genestrings Diagnostic