Pregnancy and Cancer

Cancer Treatment and Fertility

Every year, many women undergo cancer treatment, facing difficulties, fears, and uncertainties. For women of childbearing age, there's an additional unknown: the possibility of starting a pregnancy after treatment ends. Many cancer therapies, such as chemotherapy and radiotherapy on the pelvis, can induce long-term side effects affecting ovarian function, leading to infertility and premature menopause. Hormonal therapies administered over long periods can also negatively impact the endocrine and reproductive capacity of the ovaries.

Preserving Fertility: Patient Dialogue

Therefore, women of childbearing age are advised to protect their fertility using innovative techniques before starting treatment, allowing them to pursue motherhood after treatment completion. A crucial element of any therapeutic journey is the discussion between the patient and a multidisciplinary team, including an oncologist and fertility preservation specialists, to assess the individual case and choose the most suitable technique.

Unfortunately, this procedure isn't possible for all patients, as certain clinical conditions prevent such operations. Age also plays a key role: after 40, this approach is generally not used due to decreased oocyte quantity and quality.

Techniques for Preserving Fertility During Cancer Therapy

Oocyte Cryopreservation and Assisted Reproductive Technology (ART)

The first and most established method is oocyte cryopreservation. Oocytes are generally collected before cancer treatment, stored at -200°C, and thawed when pregnancy is desired. Assisted Reproductive Technology (ART) is then used for fertilization.

Ovarian Tissue Preservation

Another promising option is ovarian tissue preservation, but it's still considered experimental. A part of the tissue is surgically removed before therapy begins and stored at -200°C. It can then be reimplanted through one or more surgical operations, and after a few months, it temporarily resumes function, restoring the menstrual cycle and fertility in most patients, although for a limited duration.

Induced and Transient Menopause

Other possible solutions to protect ovarian reserve include inducing artificial and transient menopause to preserve tissues through the administration of specific medications (LHRH agonists), but efficacy data on this front isn't conclusive yet. Finally, in cases of pelvic radiotherapy, transposing the ovaries to a nearby location to shield them from radiation.

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When to Cryopreserve Oocytes and When to Conceive?

Time is crucial; speed is essential in fighting cancer. Today, unlike the past, engaging in this fertility preservation pathway is relatively quick. Previously, waiting for a specific phase of the menstrual cycle was essential, but now oocyte cryopreservation is possible at any point in the menstrual cycle, with the entire process completed in 10 to 12 days.

Timing is also essential after cancer treatment: there's no universal rule. Determining when conception is possible requires individual assessment. Factors considered include tumor type and prognosis.

For women diagnosed with cancer during pregnancy, solutions now exist.

While previously, difficult choices were necessary—suspending pregnancy or delaying treatment until after birth—encouraging evidence now exists: many cancers can be treated without jeopardizing the unborn child's health. In many cases, expectant mothers can undergo not only surgery but also chemotherapy during the second or third trimester safely.

Women's Cancers

According to the latest available estimates, the main neoplasms identified as causing women's cancers are:

• Breast cancer;
• Colorectal cancer;
• Lung cancer;
• Thyroid cancer;
• Endometrial cancer;

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