What is the potential impact of cancer and cancer treatment on a woman’s fertility? Expert Dr. Terri Woodard defines oncofertility and explains how reproductive health may be affected in women with cancer.
Dr. Terri Woodard is a reproductive endocrinologist at Texas Children’s Pavilion for Women. Dr. Woodard holds a joint appointment as an Assistant Professor in the Division of Reproductive Endocrinology and Infertility at Baylor College of Medicine and the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center. Learn more about Dr. Woodard.
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Transcript
Jamie Forward:
So, Dr. Woodard, you established the oncofertility program at MD Anderson Cancer Center. So, for those that aren’t familiar with this term, can you explain what oncofertility means?
Dr. Terri Woodard:
So oncofertility, this term was coined a couple of decades ago, actually, and it really refers to the reproductive care of patients whose fertility may be impacted by cancer or its treatment.
Jamie Forward:
Okay. Thank you for that explanation. So, let’s learn more about how cancer and cancer treatment can impact women. So, how is reproductive health affected? Is it the cancer, or is it the treatment, or is it both?
Dr. Terri Woodard:
It can be both.
So, one thing is that women are at risk for developing gynecologic cancers that can directly affect the reproductive organs. So, we’re talking about ovarian cancer, cervical cancer, endometrial cancer. So, all of those can directly affect fertility in itself.
So, in addition to cancer directly affecting the reproductive organs, there are other cancers where the treatment can actually impact infertility. So, we’re talking about things like chemotherapy or other systemic therapies, radiation, surgeries that can also impact reproductive function, as well.
Jamie Forward:
Okay. So, as far as, are there any sort of treatment? It sounds like also the treatments that could – or cancer-related therapies, I should say. So, therapies that are treating side effects, etc., of medicine, can that also have an impact on it?
Dr. Terri Woodard:
Absolutely, yes. And then, sometimes these modalities are combined, so it’s not uncommon to see someone who’s getting both chemotherapy as well as something like radiation.
Jamie Forward:
Okay. And what about hormonal therapies?
I know there’s these that are often used in breast cancer. How might they affect a woman’s reproductive health?
Dr. Terri Woodard:
So, the interesting thing about hormonal therapy is that they’re not directly gonadotoxic themselves. So, giving tamoxifen (Nolvadex), or an aromatase inhibitor, or a GnRH agonist doesn’t necessarily cause the ovary to fail. But usually, women have to be on these agents for five to 10 years, and they are not compatible with becoming pregnant. Actually, many of them will shut down the ovaries. The ones that don’t are actually teratogenic, meaning it can cause birth defects. So, the concern that we have with these agents is that while the woman’s on them for five to 10 years, she is aging, and with age, fertility declines.
But there are also other systemic therapies that are newer, like targeted agents, immunotherapy, where we don’t have a lot of data about fertility risks. So, making sure patients understand that. And the other thing about some of these agents is that they’re on them for long periods of time, so they may not be able to come off of them to get pregnant. So, those are all conversations that we should be having up front with patients before they start them.
Jamie Forward:
Sure. And what about like bone marrow transplant and stem cell, maybe CAR T-cell therapy, things like that? Or do those come into play as well?
Dr. Terri Woodard:
So, they do, and honestly, it’s ideal. So, usually by the time someone gets to bone marrow transplant, stem cell transplant, they were diagnosed some time ago. Usually, you don’t go straight there. So, the important thing is getting to those patients early before they get to that point.
And the fact is, their initial time of diagnosis, maybe the risk wasn’t thought to be that high, but now they’re needing more therapy. By the time we’re getting to stem cell transplant, it’s a little bit harder to offer fertility preservation services. Sometimes we can freeze ovarian tissue, but typically, these patients have recently had chemo, so egg freezing and things like that are not really that useful, or helpful, or effective. So, but I still think even if the patient didn’t have a conversation before having that conversation before a transplant, is very important because those are women that are at very, very high risk for ovarian failure and infertility.
So, not only the fertility piece, but also talking about what it means for needing hormone replacement therapy and things like that in the future.