The Impact of Cervical Cancer on Fertility
Cervical cancer refers to abnormal, uncontrolled growth and multiplication of cells in the cervix, the lower portion of the uterus that connects to the vagina. Cervical cancer is the fourth most common cancer in women, affecting 0.6 percent in their lifetime. If you have been diagnosed with cervical cancer or recently completed treatment for the disease, you might have questions about your fertility. When discussing treatment options with your doctor, be sure to ask about fertility impacts and options.
Impact of treatment on fertility
How a diagnosis of cervical cancer affects a woman's fertility depends on the stage and grade of the cancer, where it's located, treatment options and a woman's current fertility status. Treatment options for cervical cancer may include surgery, radiation, chemotherapy, targeted therapy, immunotherapy or a combination of choices. Each of these treatment options can have varying effects on your fertility.
Hysterectomy—removal of the cervix, uterus, upper vagina and lymph nodes—is the most common treatment for early-stage cervical cancer. Getting pregnant after a hysterectomy isn't possible, even if a woman still has viable eggs.
Radiation and chemotherapy are commonly used to treat locally advanced cervical cancers or decrease the risk of recurrence after surgery. Radiation can damage eggs and make pregnancy impossible. Cervical scarring from radiation, conization or removal of the cervix can complicate the birth process. Cervical cancer that has spread beyond the cervix may impact fertility in other ways. Getting pregnant during chemotherapy is not safe, as the drugs can damage eggs. Most women are safely able to get pregnant after a period of time that allows for damaged eggs to leave the body. Some doctors may recommend waiting six months; others, two to five years.
For women who desire a future pregnancy, fertility-sparing cancer treatment options may be available. For cancer confined to the cervix, this may include conization (or cone biopsy), which removes isolated cancerous growths in the cervix and a margin of healthy tissue. Most women can get pregnant after conization, although they may be advised to wait six to 12 months before trying to conceive. However, conization has its own risks: It may increase the risk of having a miscarriage, and it can result in scarring on the cervix, which can lead to decreased fertility.
If a large part of the cervix was removed during cervical conization, a woman could develop incompetent cervix, where the cervix opens or dilates without contractions. A stitch, or cerclage, can be placed around the cervix to prevent it from opening before labor.
Trachelectomy is an option for some women in early stages of cervical cancer. This procedure involves removal of part or all of the cervix, and possibly parts of the upper vagina and surrounding lymph nodes, but spares the uterus, where a baby grows and develops. Six to 12 months after trachelectomy, around 70 percent of women who try are able to get pregnant, and 70 percent of those who do can carry their baby to full term, at which point they give birth via C-section. Both procedures increase risk for pregnancy complications, but they also leave women with many more options.
Additional fertility options
Women who are physically able but struggling to get pregnant can pursue intrauterine insemination (IUI) or in vitro fertilization (IVF). As long as cancer has not impacted the ovaries, harvesting eggs through cryopreservation (where eggs are removed from the ovaries) and having a baby through surrogacy may be an option. A doctor can determine whether postponing treatment, such as radiation, to harvest eggs is safe. Adoption is also another choice for prospective parents.
Stay positive, do research and talk to your doctor about the many avenues available for having children. If you are a woman who wants to become a mother, one way or another, you can.