Cervical Cancer During Pregnancy | Ashley's Story
Having Children After Cervical Cancer
Cervical cancer and cervical cancer treatment can affect your chances of having a child, but certain treatments may preserve fertility.
By Krisha McCoy
Medically Reviewed by Cynthia Haines, MD
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Cancer treatments can affect fertility, making it difficult or even impossible to conceive. And this may be especially true of cervical cancer treatment. But keep in mind that infertility after cervical cancer is not inevitable. There are steps you can take to protect and preserve your fertility.
Cervical Cancer: Preserving Fertility
The most effective thing you can do to preserve your fertility? Get your yearly Pap smear.
"If patients don't get their regular Pap smear screening and don't get cervical cancer detected at an early stage, treatment may require a hysterectomy, which renders one infertile — completely," says Jill Powell, MD, ob/gyn and adjunct associate professor of obstetrics and gynecology at Saint Louis University's School of Medicine.
Cervical Cancer Treatment: How It Can Affect Fertility
Other cervical cancer treatments can have an impact, too. "Chemotherapy and radiation can also affect fertility," says Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society.
If your uterus (womb) has been removed through a hysterectomy, you will not be able to carry a child. And if your ovaries are simultaneously removed, you no longer will produce eggs.
When cervical cancer treatment involves radiation therapy, high-energy rays are aimed at your pelvis to kill cancerous cells. This exposes your ovaries to radiation, which can damage them and destroy some or all of the eggs, resulting in premature menopause. In addition, women who have a uterus that has been exposed to radiation are at increased risk of miscarriage and premature births due to scarring and reduced blood flow to the uterus.
Since chemotherapy drugs kill healthy cells along with cancerous ones, there is a risk that they will damage some of the eggs that are stored in your ovaries. This can put you at risk of miscarriage and early menopause.
Even treatment for precancerous cells in the cervix can affect a woman's ability to have children. "The treatment for precancer can weaken the cervix and affect a woman's ability to carry the pregnancy to term," says Dr. Saslow. These treatments include LEEP and cone biopsy procedures that remove a part of the cervix.
Dr. Powell adds that "the problem with these procedures is when you need to remove a larger portion of the cervix. The tissue left behind can scar shut, causing a condition known as cervical stenosis.” This condition prevents sperm and egg from meeting.
Having too much cervical tissue removed can cause the cervix to weaken, a condition known as cervical incompetence where "the cervix can open painlessly, even without contractions, and lead to miscarriage in the second or early third trimester," says Powell. The fix is a stitch that holds the cervix closed, known as a cerclage, she explains.
Another issue is that if too many of the cervical glands, which are needed to make fluid for sperm movement through the cervix to the uterus, are removed, it can cause sperm to dry out and become unable to fertilize an egg. "The less tissue you can remove from the cervix, the better" for fertility, says Powell.
Fertility Options for Women with Cervical Cancer
It is important that you talk with your medical team about your options if you are about to undergo cervical cancer treatment and would like to have children. Here are points to consider in dealing with cervical cancer and preserving your fertility:
Catch it early.If you are being treated for precancerous cells of the cervix, discuss your options with your doctor. It may be feasible to remove the smallest amount of cervical tissue possible if your cancer is in its earliest stages. This can lower your risks of fertility-harming side effects like cervical stenosis and cervical incompetence.
Get a "trach."Even in more advanced cases, your doctor may be able to perform a trachelectomy, a procedure that involves removal of the cervix while stitching the lower part of the uterus together. A trachelectomy leaves your uterus intact so you may still be able to carry a child. Pregnancy following this procedure will still involve reproductive technologies, according to Powell, but many women can have a successful pregnancy going this route.
Save an ovary.Your doctor may be able to spare one, or both, of your ovaries during a hysterectomy, which can both preserve your eggs and reduce menopausal symptoms. You would also have the option of harvesting one of your own eggs for a surrogate pregnancy; this is when another woman is impregnated with an embryo formed with your egg and sperm from your partner or a donor.
Consider your options.Some chemotherapy regimens are less likely to cause problems with fertility, depending on the type of medications, doses, and combinations, so talk about your options with your doctor. And various shields can be used with radiation, so discuss that with your doctor as well.
The Future Holds Promise for Women With Cervical Cancer
Fertility in women undergoing cervical cancer treatment "is definitely an issue that is being worked on," says Saslow. "Some studies have been published that have shown positive results."
For example, in an experimental procedure, researchers transplanted a woman's ovary into her arm during cervical cancer treatment to protect the ovary from damage from radiation. Separate research is investigating the effectiveness of other approaches, such as shielding the ovaries during radiation and harvesting eggs before treatment.
What You Can Do Now
No matter what your situation, if your cervical cancer treatment is affecting your ability to have a child when you want one, it can be emotionally draining.
Adoption is a wonderful way to bring a child into your life, but grieving the loss of your potential to bear a biological child is difficult nonetheless.
Consider joining a support group where you will meet other women in your situation or talking with a therapist to help you cope during this challenging time.
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