A cervical cancer diagnosis rarely causes infertility directly. Instead, the primary factor determining future fertility is the type and extent of the treatment required to eliminate the disease. Since cervical cancer often affects women during their reproductive years, medical advancements prioritize both cancer survival and the preservation of reproductive potential. Treatment decisions depend heavily on the cancer stage, tumor size, and whether the patient wishes to maintain the possibility of conceiving and carrying a pregnancy.
The Impact of Early-Stage Cancer Treatments
For women diagnosed with pre-invasive lesions or very early-stage cervical cancer, treatments are often fertility-sparing, focusing on removing only the cancerous or precancerous tissue. Procedures like the Loop Electrosurgical Excision Procedure (LEEP) or cold knife cone biopsy remove a cone-shaped wedge of the cervix containing the abnormal cells. While highly effective, removing a portion of the cervix can slightly increase the risk for certain pregnancy complications.
These procedures may leave the cervix shorter, affecting its ability to remain closed under the weight of a growing pregnancy. This condition, known as cervical incompetence, increases the risk of premature birth (typically before 37 weeks) or low infant birth weight. Additionally, the healing process can cause scar tissue to form, leading to cervical stenosis. This narrowing of the cervical opening can prevent sperm from entering the uterus or cause difficulty with menstruation.
For localized, small Stage I cancers, a radical trachelectomy offers an effective, fertility-sparing alternative to a full hysterectomy. This extensive surgery removes the cervix, the upper part of the vagina, and surrounding tissue, but leaves the main body of the uterus and the ovaries intact. A permanent stitch, known as a cerclage, is typically placed at the bottom of the uterus to help support the pregnancy.
The pregnancy rate for women attempting to conceive after a radical trachelectomy is high, often ranging from 55% to 73%. However, due to the removal of the cervix and the cerclage, all pregnancies following this procedure require delivery by Cesarean section. The risk of premature delivery remains a challenge, with reported rates of preterm birth around 46% to 49%.
How Advanced Treatments Affect Fertility
When cervical cancer is more advanced, or when early-stage treatments are not appropriate, more aggressive therapies are needed, often leading to definitive infertility. The most common surgical intervention for invasive cervical cancer is a radical hysterectomy, which involves the complete removal of the uterus and the cervix. Since the uterus is necessary to carry a pregnancy, this surgery results in the irreversible loss of the ability to conceive and bear children.
Radiation therapy, often combined with chemotherapy, is standard for advanced stages or for patients who cannot undergo surgery. When radiation is directed at the pelvic area, it inevitably exposes the reproductive organs to high doses of energy. This exposure is damaging to the uterus, causing scarring and fibrosis that can compromise its blood supply and ability to stretch. Consequently, the uterus becomes physiologically unable to safely carry a pregnancy.
Radiation and certain chemotherapy drugs also directly damage the eggs stored in the ovaries, often causing premature ovarian failure. This results in infertility and brings on early menopause, leading to the loss of natural hormone production. The degree of permanent ovarian damage depends on the specific chemotherapy agents used, their dosage, and the patient’s age.
Fertility Preservation Options Before Treatment
For women facing treatments that risk permanent infertility, proactive consultation with a reproductive specialist is important before cancer treatment begins. The two most established methods for preserving reproductive material are egg freezing (oocyte cryopreservation) and embryo freezing. Egg freezing involves a brief process of ovarian stimulation with hormones, typically lasting 10 to 12 days, followed by a procedure to retrieve and freeze the unfertilized eggs.
Embryo freezing is a similar process, but the retrieved eggs are fertilized with sperm from a partner or donor before cryopreservation. Both techniques provide the chance to have a biological child later using assisted reproductive technology, even if treatment causes infertility. Success depends primarily on the patient’s age at retrieval and the number of eggs or embryos stored.
For patients undergoing pelvic radiation, a surgical procedure called ovarian transposition (oophoropexy) may be recommended. This technique involves surgically moving the ovaries out of the pelvis, typically high up in the abdomen, to shield them from the damaging radiation field. Ovarian transposition aims to preserve ovarian function, allowing for the continued production of hormones and, in some cases, the possibility of retrieving eggs later. However, the uterus may still be damaged by scatter radiation, meaning a future pregnancy would likely require a surrogate.