Family planning for cancer survivors

Would you like to have children? 
Discuss your wish to have children before you start treatment, even if you only want to have children in the future. Your doctor will advise you about the options for having children even if you have cancer and are undergoing treatment. 
 
For example, you can ask your doctor: 

• Can I still conceive or father children even if I am undergoing cancer treatment? 
• What steps can I take if I would like to have children in the future? 
• What are my chances of being able to have children after my eggs or sperm have been frozen? 
• Do steps to preserve fertility affect the type of cancer treatment I will be able to have? 
• Who covers the costs? 

As a female cancer patient, what steps can I take to ensure that I can have children even if I have cancer and am undergoing treatment? 
 
– Freezing eggs 
A gynaecologist removes eggs from the ovaries. The eggs are then frozen either in an unfertilised or fertilised state. The technical term for this is oocyte cryopreservation. 
In order to conceive using the frozen eggs, intrauterine insemination is required. 
 
– Freezing ovarian tissue 
A gynaecologist removes part of or an entire ovary. The ovary that has been removed is then frozen. Having completed the procedure, the doctor reinserts the ovary. After this, you can try to conceive naturally, which means without the need for a medical procedure. 
 
– Medication 
The gynaecologist can prescribe medication to stop the ovaries from producing eggs. This medication protects the ovaries from damage that can be caused by cancer treatment. 
 
– Ovarian transposition 
Before the pelvic area undergoes radiation, a gynaecologist will temporarily relocate the ovaries to another part of the body. 
 
As a male cancer patient, what steps can I take to ensure that I can father children even if I have cancer and am undergoing treatment? 
 
– Freezing sperm cells
Semen (sperm) can be frozen before you begin treatment. The technical term for this is sperm cryopreservation. Doctors can later use this sperm to perform intrauterine insemination. 
 
– Freezing testicular tissue
A doctor can remove your testicular tissue and freeze it. Doctors can extract sperm from it at a later point. Specialists refer to this as testicular sperm extraction (TESE). This procedure is used when no sperm is present in the seminal fluid. 
Doctors can later use this sperm to perform intrauterine insemination. 
 
Possible procedures for children diagnosed with cancer 
If a child is diagnosed with cancer before they reach puberty, doctors can remove a piece of testicular or ovarian tissue and freeze it. However, to date (2021), it is not possible to obtain functional reproductive cells from this immature tissue. Thanks to the progress that has been achieved in this field of research, there is every hope that this will soon be feasible. 
 
Who covers the cost of freezing? 
Patients’ primary health insurance covers the freezing costs for five years. You must be under 40 years old. In addition, freezing must be carried out by a cryopreservation centre that participates in a quality assurance scheme. 
 
The Swiss Cancer League (Krebsliga) has been successful in its efforts to get health insurance companies to cover these costs. Other procedures, such as intrauterine insemination or IVF, must be paid for by patients themselves. 
  
Cancer treatments and birth defects in the unborn child 
The risk of an unborn child developing a birth defect is not any higher following cancer treatment. However, the level of knowledge among experts in the field alone is not enough to rule out a residual risk. 
 
– Contraception is key while undergoing therapy 
Cancer treatments can affect the quality of sperm or eggs and lead to birth defects in the unborn child. This is why it is important to use contraception during sexual intercourse when patients are undergoing treatment and for some time afterwards. For this reason, you should postpone a pregnancy until after your treatment has ended.

Questions about family planning? Discuss them with your doctor. 
 
Can I pass cancer on to my children? 
The majority of people suffering from cancer will not pass it on to their children. However, some cancer patients can pass on a predisposition to certain types of cancer to their children. This predisposition increases the risk of getting cancer. Not everyone with a predisposition goes on to develop cancer. 
 
How do I know if I have a predisposition? 
Speak to your GP about this if you have many relatives in your family who have had cancer, or if any of your relatives were diagnosed with cancer at a very young age. 
 
Where can I get more information and advice? 
 
– The doctor treating you 
Talk to your doctors if you would like to have children. They will be able to advise you, and can also refer you to a fertility centre if you wish. 
  
– Swiss Cancer League 
You can obtain free advice from the cancer helpline and the regional and cantonal Swiss Cancer Leagues. 
  
– Websites on the subject of fertility 

Go to www.fertionco.ch for information on fertility for female cancer patients. You can also fill out a questionnaire on the website. It will help you decide whether or not to freeze your eggs or sperm. 

FertiSave is a specialist Swiss quality assurance network focusing on procedures to preserve fertility for cancer patients. You will find fertility centres that are part of the FertiSave network here: https://www.sgrm.org/en/informations-for-patients 

The Fertiprotekt Netzwerk e.V. is an association of centres based in Germany, Austria and Switzerland that specialise in fertility preservation: https://fertiprotekt.com/en/patients/

– Case studies 
The "Wissen gegen Krebs" (knowledge in the fight against cancer) podcast recounts the story of a young woman who opted to freeze her eggs. Have a listen. 
“A case study describing how egg retrieval has helped a young cancer patient maintain her desire to have a family: Daniela – my wish to have children in spite of cancer”