Cervical Cancer and Fertility: Exploring Options for Women

Cervical cancer affects the cervix, the part of the uterus that extends into the top of the vagina. Cervical cancer screening, with pap smears and HPV testing, can prevent almost all cervical cancers. The main cause of cervical cancer is a virus called HPV, which is sexually transmitted. Almost everyone has been exposed to HPV, but not all women who have HPV will get cervical cancer. Smoking or having a weak immune system can hurt the body’s ability to fight the virus and increase the risk for developing cervical cancer.

If you need treatment for cervical cancer, it might involve surgery, drugs that kill cancer cells (chemotherapy or immunotherapy), or radiation therapy. These treatments can affect a woman's ability to have children in the future. It is important to talk with your doctor about all your options before you start treatment.

This article will help you understand more about how cervical cancer treatments can affect your ability to have children. It will also give you information to help you make the best decision for your health.

Understanding Cervical Cancer and Fertility

Cervical cancer treatment, especially for advanced stage cancers, can take away fertility.

Early stage cervical cancer is treated with surgery, which often involves removal of the entire uterus, cervix, and surrounding tissue, sometimes including the ovaries and lymph nodes. Without a uterus, it is impossible to carry a pregnancy, but if the ovaries are preserved, it is possible to retrieve eggs to have a biologic child using a surrogate carrier for pregnancy.

Cervical cancer confined to the pelvic organs only is treated with a combination of chemotherapy and radiation.  Radiation prevents the uterus from being able to carry a pregnancy and stops the ovaries from functioning.

Cervical cancer that has spread outside the pelvis usually requires a combination of chemotherapy, medicine which kills cancer cells, and immunotherapy, which trains the body’s immune system to attack cancer cells. To prevent the cancer from returning after completing chemotherapy, you may need to be on immunotherapy for a long time, which can make pregnancy impossible. 
You are not alone in this journey. There are support systems and options available to help navigate these difficult decisions with care and compassion. 

Fertility Options to Discuss with Your Doctor

First, ensure a gynecologic oncologist is part of your care team. While medical oncologists and radiation oncologists are able to give treatment for cervical cancer, a gynecologic oncologist is a specialized OB/GYN who focuses only on gynecologic cancers and will be able to more thoroughly discuss fertility concerns and options. These considerations differ by each patient, their cancers, and their treatment goals. It is important to discuss your concerns prior to starting treatment so your expectations and questions can be thoroughly addressed and respected.

Options for fertility preservation include egg or embryo freezing, which require removing eggs from the ovaries and freezing either fertilized or unfertilized eggs. This must be done before initiating cancer treatment. If your doctor recommends radiation therapy, it is possible to surgically move the ovaries out of the radiation field, but after radiation the uterus is still not able to carry a pregnancy, so a surrogate carrier would be needed.

Emotional and Psychological Considerations

Dealing with cervical cancer and fertility implications can be emotionally challenging for women. It's essential to take care of your mental health during this time. Seeking support from friends, family, or a therapist can provide a safe space to process feelings and make informed decisions. Additionally, some organizations offer resources specifically tailored to supporting women who have faced cervical cancer and fertility challenges. These include counseling services and online or in person support groups.

Cervical cancer can significantly impact a woman's fertility, but it doesn't have to mean the end of her dreams of starting a family. By understanding the effects of different treatments on fertility and exploring available options for preserving it, women can make informed decisions that align with their values and goals.