Preserving hope: Cervical cancer and the options for women's fertility

As we observe Cervical Cancer Awareness Month this September, it is important to remember that a diagnostic label of cervical cancer does not have to extinguish a woman’s hopes of starting or expanding her family. Through comprehensive care, proactive detection, and expert medical support, many young women may find paths to preserve their fertility or explore alternative avenues to parenthood, says Affinity Health, a health cover provider.

Understanding cervical cancer

Cervical cancer arises from the cells that comprise the lining of the cervix - the lower segment of the uterus that links to the vagina. The primary cause can be attributed to persistent infections with certain high-risk strains of the human papillomavirus (HPV), a prevalent sexually transmitted infection.

The encouraging news is that cervical cancer is largely preventable and treatable, particularly when identified in its early stages. In South Africa, Pap smears and HPV testing - available through both public clinics and private healthcare practitioners - play a pivotal role in the early detection of this disease. In addition, the HPV vaccine, which is offered through school programmes and private health channels, significantly decreases the risk of developing cervical cancer in the future.

While survival remains the priority following a diagnosis, discussions around fertility preservation gain critical importance, particularly for younger women navigating this life-altering situation.

How cervical cancer can affect fertility

The influence of cervical cancer on fertility varies according to the disease's stage and the corresponding treatment methods employed.

Surgery: Procedures like cone biopsy and trachelectomy are designed to be fertility-sparing. They remove cancerous tissues while allowing the uterus to remain intact. Although many women can successfully have healthy pregnancies post-surgery, there’s an inherent risk of complications such as miscarriage, premature delivery, or the necessity of caesarean sections.

In more advanced scenarios, a hysterectomy - removal of the uterus - becomes essential, resulting in permanent infertility. If ovarian removal accompanies this procedure, it may induce early menopause.

Radiation and Chemotherapy: Radiation treatments targeting the pelvic region can inadvertently damage both the uterus and ovaries, substantially diminishing fertility prospects even with the uterus left intact. Similarly, chemotherapy regimens may reduce ovarian reserves, raising the likelihood of early menopause.

Given these factors, medical professionals advocate for discussions surrounding fertility preservation prior to commencing any cancer treatments.

Fertility preservation options

South Africa offers access to an array of established fertility preservation techniques, which can be found in private fertility clinics and certain academic hospitals.

Egg or embryo freezing (cryopreservation): Eggs can be extracted and stored prior to initiating treatment. When embryos are frozen, fertilisation with sperm occurs before storage.

Ovarian tissue freezing: Suitable for urgent cases, this method involves removing and freezing a portion of the ovary for future re-implantation. Availability of this procedure may be limited to select centres.

Ovarian transposition (oophoropexy): This surgical technique relocates the ovaries away from areas exposed to pelvic radiation to mitigate damage.

Surrogacy and adoption: For women who may be unable to carry a pregnancy post-treatment, legal surrogacy and adoption opportunities exist, although they require following specific legal and procedural paths.

It’s imperative for patients to consult with fertility specialists as early as possible, particularly since decisions concerning preservation often necessitate prompt arrangement if cancer treatment must proceed without delay.

Emotional impact of infertility risk

Receiving a cancer diagnosis at any age is a harrowing experience, but for those in their reproductive years, the added potential for infertility can invoke profound emotional distress, grief, and anxiety. Many women grapple with feelings of loss - even those who might not have been planning immediate parenthood.

Support from counsellors, psychologists, and peer support groups can prove invaluable for individuals as they navigate their emotions and make educated choices. Some women may opt to focus on fertility preservation, while others prioritise their health and recovery, contemplating parenthood later.

Ultimately, there is no universal answer; each woman’s journey will hinge on her health, personal beliefs, and aspirations.

A cervical cancer diagnosis may signify a turbulent turning point in a woman’s life, yet it does not necessitate relinquishing hopes of motherhood. With early detection, tailored treatment plans, and access to fertility counselling, many women find encouraging paths ahead. Regular Pap smears, HPV screenings, and consistent check-ups remain crucial in safeguarding reproductive health.