FAQ – Fertility

Not all chemotherapy destroys eggs and sperm to the same extent. That is why it is important to know which medication you took and in what dosage. And every individual or every ovary and every testicle reacts differently. Chemotherapy (almost) always results in the destruction of growing eggs and sperm. But not always, which is why contraception is important while you are having chemotherapy. The decisive factor is the influence on the “dormant” eggs or sperm, which can grow again once therapy has been completed. However, a certain recovery period is needed for these cells to be able to grow normally again. This is usually 6-12 months and can vary from person to person and from therapy to therapy. If your ovaries, uterus or testicles have had radiation therapy, things are different. Here, the tissue is attacked directly, but depending on the dosage. Especially in the uterus, this can restrict blood flow and make it difficult for an embryo to implant itself in the uterus wall. This is why it is important for an expert to look at your individual situation because that is the only way to be able to provide more exact/reliable answers.

Es gibt zwei unterschiedliche Zellarten im Hoden, die unterschiedlich geschädigt werden können durch eine Krebstherapie. Die sogenannten Leydig-Zellen sind für die Testosteronproduktion verantwortlich und in den In den sog. Sertoli-Zellen findet die Spermienproduktion und- reifung statt. Die Leydig-Zellen sind robuster gegenüber Chemo- oder Strahlentherapie. Daher kann es sein, dass zwar die Testosteronwerte normal sind, aber dennoch keine Spermien mehr vorhanden sind. Ob noch Spermien vorhanden sind nach der Krebstherapie hängt vor allem von dem Überleben von spermatogonalen Stammzellen ab, also den Reservezellen, aus den immer wieder Spermien heranreifen. Dies kann man jedoch herausfinden, indem ein Spermiogramm, also eine Analyse der Samenflüssigkeit ( Ejakulat) durchgeführt wird.

For puberty to take place “spontaneously”, in other words without hormone therapy, the body, or rather the ovaries, have to produce hormones themselves. When puberty happens spontaneously, i.e. naturally, the ovaries are also active during this time. To be fertile, you need eggs, ovulation and a functioning uterus.  Menstrual bleeding that comes regularly, i.e. once a month, requires at least a residual function of the ovary. Although having spontaneous menstrual bleeding is a rather good sign at first, it does not tell you how many eggs are left, how long the ovary will continue to function or whether you’ll ovulate at all. This can be checked in more detail by determining hormone levels and with an ultrasound. The costs for these tests are covered by your basic insurance.

Being fertile means you have eggs and a uterus which is capable of coping with a pregnancy. Hormone tests can be carried out on a blood sample to check how many eggs are left. This should take place at the beginning of your cycle, in other words shortly after your period has finished. Here, the Anti-Müllerian hormone (AMH for short) is crucial, as is the follicle-stimulating hormone (FSH) together with estradiol. AMH is produced by the “dormant” follicles and can give an indication of how many eggs are still there that cannot be seen in an ultrasound. It’s important to know that your AMH value first increases with age up until you are 24 and then drops. Furthermore, it is also influenced by your general state of health, whether you take hormones etc. That is why it is important to see this value in combination with other tests. FSH tells you how much your own body needs to stimulate your ovaries for an egg to mature. Since estradiol inhibits FSH, it is important that this value is always determined at the same time so a reliable statement can be made. The best time to do this is two to five days after the start of menstruation when your cycle is still in its initial stages. An ultrasound can also be carried out to count the follicles that get ready in each cycle. This is most easily done with an ultrasound through the vagina as the ovaries are located close to the vagina and are best visible this way. If you do not like the idea of this kind of ultrasound or you are still a virgin, an ultrasound of the stomach would be an alternative. In this case, you should ensure that your bladder is full as this improves visibility and also reduces obstructions from the bowel. These tests tell you how many eggs are left, not how fertile you are. Because you can get pregnant with only a few eggs. It therefore makes sense to have these tests if you want to know your current status and are perhaps considering freezing eggs. You should also know that the costs of determining AMH are not covered by all health insurance companies and total between around CHF 50 – 80. All other examinations are covered by your basic insurance. If you have had radiation treatment of the uterus, it is important that you know how high the dosage was. An ultrasound can be used to measure the thickness of the endometrium (the lining of the uterus) which is needed, among other things, for the implantation of an embryo.

There are many ways to support an unfulfilled desire to have children, both on a psychological level and on a medical level. However, there is no one answer to this. What you can do depends on how limited fertility is. Counselling and medical consultations are required in order to be able to clarify this question in each individual case.

It is important to know that you should not get pregnant during cancer therapy or until six months after your cancer therapy has been concluded so make sure you use birth control when having sex during this time. If you get pregnant after this time the risk of having a healthy or unhealthy child is just as high as for patients who have not had cancer. There is also no indication that children of people affected by cancer have a higher risk of getting cancer themselves. Naturally, the situation is different if your cancer has a genetic cause. But that is also something that needs to be discussed on an individual basis.

Eggs: It is always certainly a good idea to see how many eggs there are to be able to estimate how many can be harvested. It is also important to know that, like the eggs, an ovary also has to go through a maturing period. We now know that eggs need at least two years to mature after the start of your first menstrual cycle. Therefore, the general recommendation is to freeze eggs only from the age of at least 16, preferably 18, in order to have a realistic chance of pregnancy later on. And yes, it’s a good idea if there is a lower number of eggs or there is a risk of the number dropping quickly. Cancer therapy has no influence on the quality and you can have healthy children with these eggs providing they are mature.

Sperm: To see whether you have sufficient sperm, you can have your seminal fluid (ejaculate) tested. This should take place at the earliest 6 months but preferably 12 months after the end of cancer therapy. This is how long the testicles need to start producing sperm again. This then usually remains stable, unless the sperm count is very low. This could indicate a risk of production stopping altogether. In this case it would make sense to have sperm frozen just in case. If very few sperm are available, it might be an option to freeze testicular tissue. This has to be decided on an individual basis. Please consult an expert to discuss your options in person.

The costs for testing your fertility are covered by your basic insurance, the only exception is the determination of AMH (see “How do I know if I am still fertile? Are there tests that can find that out? What kind of tests are they?”). Unfortunately, the costs of freezing egg and sperm AFTER completed cancer therapy are not yet covered. Your fertility clinic will be able to provide you with details of the costs.

If eggs or sperm are no longer available, you could consider the option of a egg or sperm donor. In Switzerland, sperm donation is allowed providing the couple is married and can prove that there is no more sperm available.

Unfortunately, egg donation is not yet allowed in Switzerland. But egg donation is possible abroad. Make sure you find out exactly where this is possible and under what conditions. Here too it is important that your uterus is capable of coping with a pregnancy. This can be difficult, particularly if you have had radiation therapy in your pelvic area.  This can also be clarified individually in advance.

There are several centres in Switzerland that have specialised in freezing eggs/sperm. They are fertility clinics, in other words specialists for fertility issues in both men and women. There is also a list of centres that have specialised in these issues with a particular focus on cancer patients, especially on preserving fertility before cancer therapy. You will find this list of centres here: https://www.sgrm.org/de/kommissionen/fertisave-main-de/fertisave-zentren . We would be happy to offer first testing or counselling and you can then decide if, and where, you would like to have your eggs/sperm frozen. You can of course contact the relevant centres directly yourself.

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