How can I conceive with urothelial cancer at 39 years old?

Question

Hello doctor,

I have recently been diagnosed with metastatic urothelial carcinoma, and honestly, I am feeling completely lost. I am 39 years old and was planning to try for a baby soon, but now with all these treatments being discussed, chemotherapy, immunotherapy, I do not know what is possible anymore. Also, my periods have suddenly become irregular since this whole stress began, and I do not know if it is related to the cancer or hormonal changes from stress.

Will these treatments make me completely infertile?
Should I consider egg freezing before starting therapy, or is it too late?
Can I still use any form of birth control safely while undergoing treatment?
I have read that some hormonal contraceptives are not recommended for cancer patients. What are my options?
And in case I survive and want to try IVF (in-vitro fertilization) later, is that even safe after such an aggressive cancer?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

You are facing this diagnosis at such a young age and at a time filled with so many plans for the future. It is normal to feel lost, and your questions are valid and critical to address as we plan your care. Unfortunately, yes, there is a very high likelihood that chemotherapy will lead to premature ovarian failure and permanent infertility. This is one of the most difficult side effects for women in your situation. Immunotherapy's specific impact on fertility is less well-documented, but the chemotherapy given with it is the primary concern.

Is it too late for egg freezing?

This is the most urgent question. It is likely not too late, but this must be addressed with extreme urgency within days. You must speak to your oncologist immediately about a referral to a fertility preservation specialist who is an endocrinologist. They can perform a rapid assessment. The process of egg stimulation and retrieval takes approximately two weeks.

Your oncology team can often delay the start of your life-saving treatment for this short, critical window. It is a way to preserve a piece of your planned future. Your irregular periods are almost certainly related to the immense physical and emotional stress of your diagnosis. Severe stress can disrupt the hypothalamic-pituitary-ovarian axis, leading to cycle irregularities. While the cancer can contribute, the timing makes stress a very likely cause.

Your safest and most recommended option for birth control during treatment is non-hormonal methods. The most effective are barrier methods like condoms or a diaphragm. A copper intrauterine device (IUD) is a highly effective, long-acting, non-hormonal option that can be inserted before treatment begins. It is important to discuss this with your oncologist and gynecologist to ensure it is appropriate for you.

This is a question of hope, and it is important to have. Yes, if you can undergo successful fertility preservation now, pursuing IVF (in-vitro fertilization) after your cancer treatment is complete is a possibility. The safety of a future pregnancy would depend on several factors once you are in remission, including the specific treatments you received and your overall health, and the advice of both your oncologist and a high-risk obstetrician. Many cancer survivors go on to have healthy pregnancies using their frozen eggs or embryos.

Please do take regular follow-ups. An urgent oncology consult is required. Discuss immediate referral to reproductive endocrinology for fertility preservation to assess the feasibility of a two-week delay in chemo starting.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.