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- Assessing fertility after treatment
Assessing fertility after treatment
After cancer treatment, you may want to do some tests to see how your fertility has been affected. The results will help the specialist recommend the best options for having a child after cancer treatment.
If you weren’t able to preserve your fertility before starting cancer treatment, you may still be able to do this after treatment. In this case, it is better to have any fertility tests soon after cancer treatment ends.
Otherwise, you may decide to wait until you feel physically and emotionally prepared to know the results – this may be months or even years later. A partner, friends, family or your medical team might provide support to you when you receive the results.
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Your fertility specialist or reproductive endocrinologist can organise a number of tests to assess your likely fertility status after treatment.
Follicle-stimulating hormone (FSH)
A blood test can measure the hormone FSH, which may indicate how close to menopause you are. This hormone is produced in the pituitary gland, and stimulates the follicles in the ovaries, which will in turn release eggs. FSH levels need to be measured on specific days of the menstrual cycle – usually the first couple of days – as levels change throughout the month.
An ultrasound uses echoes from soundwaves to create a picture of the cervix, uterus, fallopian tubes and ovaries. A technician will insert an ultrasound wand into the vagina. It will be covered with a disposable plastic sheath and gel to make it easier to insert.
Antral follicle count (AFC)
An ultrasound wand is inserted into the vagina to show the number of follicles in the ovaries. Each follicle contains a single immature egg.
An ultrasound probe is inserted into the vagina to show the size of the ovaries. Smaller ovaries usually contain fewer eggs, which may make it more challenging to become pregnant.
Anti-Müllerian hormone (AMH)
This blood test measures AMH, which is a hormone secreted by the developing egg sacs (follicles). The level of AMH in the blood is only an estimate of the number of eggs left in the ovaries. It does not reflect egg quality or the ability to have a baby. AMH is usually low after cancer treatment but sometimes increases after you’ve recovered from chemotherapy.
This is produced mainly in the ovaries. The level of oestradiol rises and falls throughout the menstrual cycle so a single measurement does not give good information about fertility.
Luteinising hormone (LH)
A blood test can measure LH levels. This hormone helps the ovaries release an egg. High levels of LH may be a sign that your ovaries have stopped working (premature ovarian insufficiency).
After treatment, you may be able to have an erection and ejaculate, but this doesn’t necessarily mean you are fertile.
Semen analysis (sperm count)
This test can show if you are producing sperm and, if so, how many there are, how healthy they look and how active they are. You will go into a private room and masturbate until you ejaculate into a small container. The semen sample is sent to a laboratory for analysis. The results will help the fertility specialist determine whether you are likely to need help to conceive.
Follicle-stimulating hormone (FSH)
A blood test can measure FSH. This hormone is produced in the pituitary gland. In males, FSH encourages sperm production.
If FSH levels are higher than normal, this is a sign that fewer sperm are being produced. If FSH levels are lower than normal, this indicates that the pituitary gland is damaged. This will affect the number of sperm produced. This does not necessarily mean that sperm production is too low for a pregnancy but it is a sign of whether or not fertility has been affected.
Luteinising hormone (LH) and testosterone
A blood test can measure LH and testosterone levels. LH is important in fertility, because it maintains the amount of testosterone that is produced by the testicles. This also helps with sperm production, muscle strength and general sexual health including sex drive (libido).
Like many hormones in the body, LH and testosterone levels are different at different times of the day. They are highest in the morning, so the test is done earlier in the day. It is important to tell your doctor whether or not you’ve been using marijuana, as this will lower LH and testosterone levels.
If you stored sperm in a sperm bank before cancer treatment, your doctor can compare this sample to your sperm sample after treatment.
A small number of people have a greater risk of developing certain cancers, such as breast, ovarian or bowel cancer, because they carry a changed gene. You can discuss the risk of any future children inheriting one of these changed genes with your doctor or a genetic counsellor.
If your cancer specialist has identified a gene that may have contributed to the growth of the cancer, you may consider having a pre-implantation genetic diagnosis (PGD) test as part of IVF. While the embryos are developing in the laboratory, a few cells are removed from each embryo and tested for genetic conditions.
Embryos that are PGD-tested will be frozen until the results are available. Only unaffected embryos are implanted into the uterus, reducing the chance of the faulty gene being passed onto the child. You can discuss this option with your fertility specialist.
If you are concerned about your family history of cancer, visit a familial cancer centre for advice. To find a familial cancer clinic, visit Cancer Council Australia.
Dr Ying Li, Gynaecologist and Fertility Specialist, RPA Fertility Unit, Royal Prince Alfred Hospital, NSW; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, NSW, and Lead Clinician for Youth Cancer NSW/ACT; Paul Baden, Consumer; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland; Maurice Edwards, Special Counsel, Watts McCray Lawyers, NSW; Helena Green, Clinical Sexologist and Counsellor, InSync for Life, WA; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, VIC; A/Prof Kate Stern, Gynaecologist and Reproductive Endocrinologist and Head, Fertility Preservation Service, Royal Women’s Hospital Melbourne, The University of Melbourne, VIC; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Resea ch Institute (THRI), School of Medicine, Western Sydney University, NSW; Renee Van Den Bosch, Consumer.
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