Fertility Issues Among Female Survivors

February 9, 2010

Fertility issues or complete loss of fertility is faced by a significant number of women who have undergone treatment, which affected directly or indirectly, their reproductive organs.  There has been a major push, including 2006 recommendations by the American Society of Clinical Oncology, to develop better communication and awareness on this topic. Unfortunately many gynecologic cancers may prevent the most popular “fix” for the problem – fertility preservation - but this may be an option for many women who are at risk for cancer-related infertility. Fertility preservation is really a catchall term that describes the effort to retain fertility or the ability to procreate in the future. In both the survivorship world and the world in general, loss of fertility has been identified a very serious emotional and mental stressor. Currently, much of our understanding of female sexuality and fertility issues among cancer survivors is derived from studies of breast cancer survivors, so there is a need to expand the populations in which these issues are studied. On the other hand, there are many experts in the fields of survivorship and psycho-oncology who suggest that many of the lessons learned from breast cancer survivors are applicable across other female survivor populations. Regardless, this is an issue that deserves the attention of researchers worldwide and locally. Here in CT, this year’s annual Cancer Survivorship Symposium sponsored by the Connecticut Challenge Survivorship Clinic at Yale Cancer Center will focus on “sexuality and cancer survivorship.”

Loss of fertility among female survivors is highly associated with premature menopause. This early menopause is associated with increased menopause-related symptom severity and increased number of menopause-related symptoms. In short, cancer-related fertility impairment is a mess of situation, and it is correlated with a host of unpleasant (to say the least) problems. In a paper published in early February 2010 in the journal Breast Cancer Research and Treatment, researchers state “Reported reproductive concerns after breast cancer treatment were a significant contributor to consistent depressive symptoms,” and the authors go on to say, “Younger survivors would benefit from additional information and support related to reproductive issues.”

In the January 2010 issue of the International Journal of Gynecological Cancer, researchers reported results that suggest that among women with cancer-related loss or impairment of fertility, “distress” and “depression” were associated “with the severity and number of menopausal symptoms reported.” In other words, the researchers found that the level of distress and depression likely to be found in survivors increased as the severity and the number of premature menopausal symptoms experienced by the survivors increased.

The long-lasting and complicated effects of loss or impairment of fertility can have devastating emotional effects on survivors and their families. Survivors (frankly both male and female survivors) should discuss fertility issues with their treating physician, and the conversation should happen early because fertility preservation is easier to accomplish through various methods earlier in treatment (actually soon after diagnosis is best). If fertility has become an issue and fertility preservation is not an option or has not been addressed in time, survivors and their partners should strongly consider counseling to deal with the emotional burden and to develop alternative plans.

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