Cancer treatment has ended

Going through radiotherapy or chemotherapy is a very stressful physical and mental process. Upon completion of cancer treatment you and your relatives need time to come to terms with everything and regain stability over your life.
But when you are sufficiently recovered from your cancer treatment you may want to know your fertility status. To this end you can call on the CRG. By means of a number of tests we can try to find out to which extent cancer treatment has affected your fertility.
We can also do this for young people who underwent cancer treatment in their childhood: as soon as puberty is reached, we are able to test and monitor their fertility.

For an appointment or more information: contact the oncofertility coordinator.

Do you want to have children soon? Please look under ‘What if you want to have children’? to see what your options are and what the alternatives are when you have unexpectedly lost your fertility.

As discussed under What is gonadal toxicity? the ovaries of a woman are highly susceptible to the effects of chemotherapy and irradiation. As a result, women have an increased risk of early or premature menopause after cancer treatment.
Unfortunately, early menopause will often result in complete infertility. Menopause is also associated with other health problems: vaginal dryness, loss of libido, osteoporosis in the long term and an increased risk of cardiovascular diseases.
Therefore, monitoring your hormonal status and fertility after cancer treatment is very important.

It is difficult to predict when your menstrual cycle will spontaneously recover after cancer therapy. There is important variation among women and this variation depends on several factors, such as the dose of chemotherapy, your age, the remaining egg cell reserve, etc. Your menstrual cycle may not resume for several months, sometimes even longer.
Of course it is usually a beneficial sign if your menstrual cycle starts again after finishing cancer treatment. But even then, we cannot just assume that your reproductive function is fully back to normal. You may well have a regular menstrual cycle for some time but still have a risk of early menopause. The use of hormonal birth control methods may also mask the occurrence of premature menopause.
In order to draw firm conclusions about the status of your fertility, additional blood tests and an ultrasound scan of the ovaries are required.
A blood test allows us to define a detailed hormonal profile. The most important parameters we measure are FSH and AMH (Anti-Müllerian hormone).
FSH (follicle-stimulating hormone) is the hormone which stimulate the egg cells to mature in the ovaries. If the blood test shows a normal FSH value, this indicates that egg cell maturation is likely to occur properly. The AMH level gives information about how many primordial follicles are left in the ovaries.
After the blood test we will check these results against a follicle count performed by means of a transvaginal ultrasound scan of the ovaries. The CRG gynaecologist will discuss the results of both analyses with you and discuss potential treatment approaches.

If the tests after your cancer treatment reveal that your ovaries are working properly, it is important to have these tests done regularly. You are at risk of reaching menopause much quicker than women who never had cancer treatment, because your egg cell reserve may have been affected.
The Oncofertility team recommends not to delay your attempts to have children but to go for it as soon as your health condition allows you to get pregnant. In practice this will mean that approximately two years will elapse between the end of cancer treatment and your active attempts to become pregnant. However, this interval depends on the type of cancer you had and should be discussed with your oncologist.
If your menstrual cycle resumes after cancer treatment, but you are not (by far) up to having children, you have another option to protect yourself against the risk of early menopause. You may want to undergo a partial fertility treatment, comprising hormonal stimulation of the ovaries, followed by an egg cell pick-up and cryopreservation of egg cells.
If you have a partner with whom you want to have children, you may also have the egg cells fertilized by his sperm and freeze the resulting embryos.
See The cancer treatment is about to start.

Please note! The Oncofertility team will not start up hormonal stimulation before receiving the go ahead from your oncologist or haematologist.

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