How to preserve my fertility before starting cancer treatment?

Question

Hi doctor,

I am a 44-year-old woman who was recently diagnosed with bladder cancer, and I am feeling quite overwhelmed. The doctors informed me that it’s in the muscle-invasive stage, and I might need chemotherapy followed by surgery.

I am terrified about how this could affect my ability to have children in the future. I have not had kids yet, and my partner and I were planning to start IVF next year.

Will chemotherapy or bladder removal surgery cause infertility or early menopause?
Are there any fertility preservation options I should consider before starting treatment?
If my uterus or ovaries are left intact during surgery, is pregnancy still possible later through IVF or surrogacy?
Additionally, I have been experiencing irregular bleeding and pelvic pain. Could those symptoms be related to either the cancer or the side effects of treatment?
Are there any hormonal changes or sexual function issues I should expect after surgery or radiation?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I am deeply concerned about your worries regarding muscle-invasive bladder cancer in women. This condition is typically treated with chemotherapy (specifically a neoadjuvant cisplatin-based regimen) before surgery, followed by a radical cystectomy, which involves the removal of the bladder and nearby organs. It is important to understand that these treatments can affect fertility and the timing of menopause.

To address your concerns about the side effects of chemotherapy, drugs like Cisplatin can damage ovarian follicles, leading to temporary or permanent infertility or early menopause, particularly in women over 40. The risk of these side effects increases with age and the cumulative dose of the medication.

In many cases, radical cystectomy involves the removal of the bladder, uterus, ovaries, fallopian tubes, and part of the vaginal wall (a procedure known as anterior pelvic exenteration).

If the uterus or ovaries can be safely preserved, depending on the location and spread of the tumor, there may still be potential for fertility. However, pregnancy after bladder cancer surgery is rare.

Now, let us discuss your fertility preservation options that you can consider before starting treatment. It is crucial to request a referral to a reproductive endocrinologist urgently before beginning chemotherapy or surgery.

Here are a few options you might explore if you have time before treatment:

Egg or embryo freezing: This is the most established and effective method. The process takes about two weeks to complete a cycle. If you have a partner, embryos can be created and frozen; if not, eggs alone can be stored.
Ovarian tissue cryopreservation: This option is useful if chemotherapy must start immediately. A surgeon will laparoscopically remove part of an ovary and freeze the tissue for later reimplantation.
Ovarian suppression with gonadotropin-releasing hormone agonist (GnRH agonist) such as Leuprolide: This approach may offer some protection for ovarian function during chemotherapy, although it is less reliable than egg freezing.

Regarding pregnancy possibilities after treatment:

If your uterus and at least one ovary remain, you might be able to conceive naturally or through IVF (in vitro fertilization) in the future, though this depends on radiation exposure and your ovarian reserve afterward.
If the uterus is removed but the ovaries are spared, you could still have biological children through surrogacy using your eggs.
If both the uterus and ovaries are removed, pregnancy would not be possible with your own eggs, but there are still options available with donor eggs and gestational surrogacy.

It is vital that you consult a urologist for further treatment guidance.

Thank you.