27 APRIL 2015

Can I have children after cancer?

Contributed by: Dr See Hui Ti

For a cancer survivor, deciding to have a baby raises special considerations. Both male and female cancer survivors have to contemplate a number of emotional and physical factors before starting or adding to their families.
Dr See Hui Ti, Senior Consultant, Medical Oncology, at Parkway Cancer Centre explains why having a baby after cancer treatment is usually safe for all parties, including the child.

How long should cancer survivors wait after active treatment to start trying for a baby?

This really depends on what kind of cancer the person has at his or her age. There are four different types of cancers that usually occur in males from the ages of 21 to 35. They include sarcomas, germ cell tumours, leukaemia and lymphomas. Many of these cancers that occur at this age are highly curable.

The main concern for males is to ensure that the sperm count is not affected during the intensive treatment. Therefore, there is always the option of banking sperm before treatment starts so as to provide the sperm for in-vitro fertilisation in case it is required.

Once treatment ends and the patient goes into remission for a few years, he can consider having children. Usually the post-treatment sperm count recovers and men can have kids in the usual fashion.  However, the sperm in the bank is a back-up plan.

Women of childbearing age also present with the same four types of cancer as males, but they also suffer from breast and ovarian cancers. When a lady goes into remission after a diagnosis of lymphoma, leukaemia or sarcoma, she could consider having children after her health recovers.

There are generally no hard and fast rules about the interval between the cancer treatment and when to start having children.  The prognoses of different cancers are different so each patient has to discuss the interval of waiting with their healthcare professional.

A certain type of cancer such as estrogen receptor positive breast cancer requires the survivor to receive Tamoxifen treatment for a total of five to 10 years. Hence patients may be asked to wait at least four to five years before considering having children.

The risk of recurrence of cancer during pregnancy also depends on the original stage of the cancer. But if the breast cancer is triple negative then patients may only wait perhaps two years before considering having a child.

Are there specific types of cancer that would make having children completely impossible?

If a woman has uterine cancer and has to have her womb or ovaries removed, she can never have children. However, there will be options such as having her eggs extracted, and stored for surrogacy purposes.

Ovarian cancer is another such cancer; if both ovaries are affected they will need to be removed. If only one ovary is affected, she can bank it for egg storage. Similarly, women with breast cancer can also store their ovaries before instituting treatment for ovarian function in future.

When it comes to male cancer survivors, it depends on how extensive his treatment of chemotherapy was and if it affects his sperm count. Of course, if both testes are removed during treatment then having children is out of the question – unless he went to a sperm bank before that to collect sperm from the normal testes.

What type of treatment could increase the risks of miscarriage or labour complications?

Any treatment given during the time when a woman is not pregnant will not increase the chances of miscarriage or labour complications. But if she has had cervical cancer, and it happens to be a very early cervical cancer, and if she has had a trachelectomy (removal of the cervix), there will be a slight increase in the risks because the cervix is no longer there to hold the baby in. However, there are procedures to prevent miscarriage and labour complications in such scenarios.

If chemotherapy is given during pregnancy, there is definitely a small risk of miscarriage and labour complications. But as a patient, one can choose to wait till the baby is born before starting chemotherapy.

This decision will depend on a lot of factors. During the first trimester, there is a one-in-four chance that the baby will spontaneously abort, especially if it’s a life threatening cancer. In such cases, we let it happen naturally or we abort the baby before we go on to treat the cancer and try for a baby once it is in remission.

For example, a 23-year-old patient was eight weeks pregnant when she found out she had leukaemia. There was no way the baby would have survived with the leukaemic complications because there would be low blood count and bleeding.

But if we are looking at a breast cancer patient in her second trimester, when the baby has already formed, and all his or her organs have already developed, that’s the best time to be instituting chemotherapy; this way we can control the cancer until the baby is born, then surgery is done. The same goes for ovarian cancer and germ cell tumours, if these are found during the latter part of the second trimester, we can either start treatment or wait for three to four weeks and have the child born premature, then start treatment.

Chemotherapy can be given to the patient during the second and third trimester without subjecting the baby to premature birth. All of these factors have to be taken into context, and the worst-case scenario is IUGR – intrauterine growth retardation (i.e. poor growth of a baby in the mother’s womb during pregnancy) – but there are usually no complications of brain damage.

All patients who are considering having children after a cancer diagnosis should feel free to discuss this with their doctor.

By Charmaine Ng

POSTED IN Life after Cancer
TAGS cancer & pregnancy, germ cell cancer
READ MORE ABOUT Cervical Cancer, Ovarian Cancer, Sarcoma