Cervical cancer develops in the cells of the cervix, the lower part of the uterus that connects to the vagina. A diagnosis does not automatically mean an inability to have children. The possibility of having children after cervical cancer depends on the cancer’s stage, characteristics, and chosen treatment. Recent advancements offer more options for fertility preservation.
How Cervical Cancer and Its Treatments Affect Fertility
Cervical cancer can impact fertility, especially if advanced and spread to other reproductive organs. The most significant impact often stems from cancer treatments.
Standard surgical treatments, like a radical hysterectomy, remove the uterus and cervix, ending the ability to carry a pregnancy. Hysterectomy is often necessary for advanced cases. Pelvic radiation therapy can also severely affect fertility by damaging the ovaries, potentially leading to premature menopause. Additionally, radiation can scar the uterus, making it difficult to carry a pregnancy to term due to reduced elasticity and blood flow.
Chemotherapy drugs can also negatively affect ovarian function. Certain agents may cause temporary or permanent infertility by damaging eggs within the ovaries. The extent of fertility impact from chemotherapy varies depending on the specific drugs, dosage, and individual’s age.
Fertility-Sparing Approaches to Treatment
For individuals with early-stage cervical cancer who wish to preserve their fertility, several medical interventions are available. These options are typically considered when the tumor is small and confined to the cervix. Eligibility is determined by a thorough evaluation of the cancer’s characteristics, including tumor size, depth of invasion, and lymph node involvement.
Conization, also known as a cone biopsy, involves removing a cone-shaped piece of cancerous tissue from the cervix with a healthy margin. Used for very early-stage cancers, it has minimal impact on future fertility, though it may slightly increase the risk of preterm birth.
Radical trachelectomy is another fertility-sparing surgery. It removes the cervix, a portion of the upper vagina, and surrounding supportive tissues while leaving the uterus intact. This preserves the ability to conceive and carry a pregnancy. A cerclage, a stitch to support the remaining uterine opening, is often placed to help maintain pregnancy.
For patients requiring pelvic radiation, ovarian transposition moves the ovaries out of the radiation field to minimize damage. This procedure aims to preserve ovarian function.
Beyond surgical interventions, fertility preservation techniques can be pursued before cancer treatment. Egg or embryo freezing, known as cryopreservation, involves stimulating the ovaries to produce multiple eggs for retrieval. These eggs can be frozen unfertilized or fertilized with sperm to create embryos before freezing. This approach is relevant for those undergoing treatments likely to cause infertility, or if a hysterectomy is required.
Building a Family After Cervical Cancer
When natural conception is not possible or if fertility-sparing treatments were not feasible or successful, alternative pathways to parenthood exist. Assisted Reproductive Technologies (ART) offer several options for individuals who have undergone cervical cancer treatment.
In vitro fertilization (IVF) is a common ART method where eggs are fertilized with sperm in a laboratory. If a woman has preserved eggs or if her ovaries remain functional but her uterus cannot carry a pregnancy, IVF with a gestational carrier can be pursued. A gestational carrier, often referred to as a surrogate, carries the pregnancy to term using the intended parent’s embryo, or an embryo created with donor eggs or sperm. This option is particularly valuable for individuals who have had a hysterectomy or whose uterus has been significantly damaged by radiation.
For individuals whose own eggs are not viable due to cancer treatment, donor eggs or embryos provide another path to biological parenthood. Donor eggs can be fertilized with partner or donor sperm, and the resulting embryo can then be transferred to a gestational carrier. This allows for a genetic connection to one parent, or no genetic connection if both egg and sperm are donated.
Adoption remains a fulfilling way to build a family, regardless of fertility status. While cancer survivors can adopt, some agencies may require a doctor’s note regarding health and prognosis, or a waiting period after treatment. Adoption processes vary, and prospective parents should consult with adoption agencies to understand specific requirements and available pathways.
Navigating Pregnancy After Cervical Cancer
For individuals who achieve pregnancy after cervical cancer treatment, specific considerations and risks require specialized medical attention. Fertility-sparing surgeries, particularly radical trachelectomy, can increase certain obstetric risks.
A common concern after trachelectomy is an increased risk of preterm birth, often occurring before 37 weeks of gestation. This is primarily due to the removal of the cervix, which normally provides structural support to the growing uterus. A cerclage helps mitigate this risk, but close monitoring is still necessary throughout the pregnancy. Cervical insufficiency, a weakening of the cervix, can also be a potential issue after procedures like conization or trachelectomy.
Prior radiation therapy to the pelvic area can also pose challenges during pregnancy. Radiation can lead to scarring and reduced elasticity of the uterus, potentially increasing risks such as uterine rupture or placental complications like placenta accreta, where the placenta grows too deeply into the uterine wall. These factors necessitate careful assessment and management.
Given these unique considerations, close monitoring by a high-risk obstetrician is important throughout pregnancy. This specialized care ensures that potential complications are identified and managed promptly. For individuals who have undergone a radical trachelectomy, a Cesarean section is typically the recommended method of delivery to prevent potential uterine injury.