Iatrogenic infertility refers to the impairment of fertility caused directly or indirectly by medical examination, treatment, or diagnostic procedures. This type of infertility is a consequence of necessary medical interventions, not a pre-existing condition.
Medical Treatments That Can Cause Infertility
Medical treatments can inadvertently affect reproductive capacity. Cancer therapies, such as chemotherapy and radiation, frequently lead to infertility. Chemotherapy drugs target rapidly dividing cells, including those in the ovaries and testicles, which are crucial for producing eggs and sperm. The extent of damage depends on the specific drugs, their dosage, treatment duration, and the patient’s age. For instance, alkylating agents are known for their high risk of gonadotoxicity, potentially leading to ovarian failure or reduced sperm production.
Radiation therapy, particularly when administered to the pelvic or abdominal areas, can significantly harm reproductive organs. High doses of radiation can destroy egg cells in the ovaries or damage the uterus, making it unable to carry a pregnancy. Similarly, radiation to the testes can impair sperm production. The impact of radiation is influenced by the field of treatment and total dose received.
Surgical procedures involving reproductive organs can directly cause infertility. A hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries) directly eliminates the possibility of natural conception. Extensive pelvic surgeries can also lead to infertility by damaging fallopian tubes, affecting blood supply, or compromising nerve function essential for reproductive health. Scarring from such procedures can disrupt the normal pathway for sperm and egg to meet.
Certain medications, when used long-term or at high doses, may also contribute to infertility. Nonsteroidal anti-inflammatory drugs (NSAIDs) can interfere with ovulation by impacting hormone release. Some antidepressants and antipsychotic medications may disrupt hormonal balance, affecting ovulation in women or causing sexual dysfunction and ejaculation issues in men. Anabolic steroids can reduce sperm count and production, while some immunosuppressants may decrease ovarian reserve.
Recognizing Iatrogenic Infertility
Identifying iatrogenic infertility involves a thorough evaluation, often beginning with a comprehensive review of the individual’s medical history. This includes detailing past medical treatments, surgeries, and medications that could potentially impact reproductive function. Healthcare providers look for a clear connection between a specific medical intervention and the subsequent onset of fertility challenges.
Fertility assessments are then conducted to determine the underlying cause of infertility. For women, these may include tests to measure hormone levels, such as Anti-Müllerian Hormone (AMH) for ovarian reserve, and imaging studies to evaluate the health of the ovaries and uterus. For men, semen analysis assesses sperm count, motility, and morphology.
The diagnostic process also involves ruling out other common causes of infertility, ensuring that the impairment is indeed linked to medical treatment rather than other factors. When diagnostic findings align with the known reproductive side effects of a past medical intervention, iatrogenic infertility is identified. This clarity helps guide discussions about family-building options.
Minimizing the Risk
Strategies exist to reduce the likelihood or severity of iatrogenic infertility, particularly when medical treatments with known reproductive side effects are anticipated. Fertility preservation is a proactive approach, offering options such as cryopreservation of gametes or embryos before treatment begins. For women, this can involve freezing eggs (oocyte cryopreservation) or embryos (embryo cryopreservation) after ovarian stimulation. Men can preserve fertility through sperm cryopreservation, where samples are collected and stored for future use.
Specific techniques can also protect reproductive organs during treatment. Ovarian shielding involves placing lead shields over the ovaries during radiation therapy to minimize their exposure. Ovarian transposition, or oophoropexy, is a surgical procedure where the ovaries are temporarily moved out of the radiation field. While these methods offer protection, some scattered radiation may still reach the ovaries.
Gonadotropin-releasing hormone (GnRH) agonists are another area of research and clinical application, particularly in women undergoing chemotherapy. These medications aim to temporarily suppress ovarian function, potentially protecting ovarian follicles from chemotherapy-induced damage. Open communication with healthcare providers before starting any treatment allows patients to discuss fertility concerns and explore suitable preservation options.
Family Building Paths
For individuals diagnosed with iatrogenic infertility, several pathways to parenthood are available. Assisted Reproductive Technologies (ART) can be a viable option, particularly In Vitro Fertilization (IVF). If an individual’s own gametes (eggs or sperm) are not viable, donor gametes can be utilized. For example, donor eggs or donor sperm can be fertilized in a laboratory setting, with the resulting embryo transferred to the intended parent’s uterus or a gestational carrier.
Surrogacy provides a path for individuals or couples when the uterus is unable to carry a pregnancy, such as after a hysterectomy or due to significant uterine damage from radiation. In gestational surrogacy, an embryo created using the intended parents’ or donor gametes is implanted into a gestational carrier who carries the pregnancy to term. This allows for a genetic connection to one or both intended parents.
Adoption is another way to expand a family. This path involves bringing a child into the family who is not biologically related. Adoption can be a choice for individuals or couples ready to welcome a child through this route. Support resources, including counseling and support groups, are also available to help individuals navigate the emotional aspects of iatrogenic infertility and explore these family-building solutions.