Hello, dear Evgeniy Olegovich.
I don’t dare hope (however, I really want) that you will remember me, but, nevertheless, now, when I am standing at a crossroads, thinking about who else I will turn to, the memory of you popped up in my head like a saving thread. Well, to make it more clear, I’ll start in order. 5 and a half years ago I gave birth to a daughter. My mother bought me your book The Beginning of Your Child’s Life. It’s not enough to say that I WAS indescribably delighted with it; I still re-read it from time to time, just to recharge myself with good emotions. And how many children grew up with it? I take care of her like the apple of my eye. When my daughter was about 5 months old, I finally made up my mind and wrote to you. And what was doubly pleasant was that you ANSWERED me. Reasonable and thorough, and even gave contact numbers. But since there were no special problems with the child, I did not consider it necessary to take you away from work or household chores. I just wrote you another letter with words of gratitude. But, probably, our mail (ordinary mail) did not deliver it to you. And, nevertheless, I want to thank you again for your work and your attention. Thank you very much, and may God grant you health, as well as strength and patience for your difficult, but so necessary work. And this is what prompted me to turn to you now. Life turned out in such a way that I left my first husband and have been in my second marriage for more than 2 years. We love each other very much. And my husband, naturally, really wants a child (he madly loves my daughter; I have never seen a more caring, patient, loving father, neither in my first marriage, nor in the families of friends and acquaintances), but due to various circumstances (figure, career, social life), I was afraid and kept putting it off. Finally we made up our minds. After all, I’m not getting any younger, and getting serious about my career means postponing the birth of a child indefinitely, or even forever. We approached this very thoroughly. We were examined by doctors. Both are healthy. I have never had gynecological diseases, and no. The doctors unanimously said forward. And then... I broke my ankle. I had to take an x-ray. There have been no delays as such (1 day). The test showed a negative result. The traumatologist sent me for surgery. I refused the operation, and then I was sent to various consultations and in the end I had to take another x-ray. I said that I might be pregnant. I was carefully covered (just like the first time). In the end, it turned out that at this stage the operation is not vital, but in any case it is necessary to contact a gynecologist. The second test gave a positive result. Because I myself can’t really walk right now (I can’t go to the antenatal clinic on crutches), my mother went... If only you could hear in what form and in what words the words of the local gynecologist were conveyed to me. Well, in a nutshell, up to 18 days of vacuum, then abortion. You’ll think it’s no big deal, then he’ll take it out. I also had to listen to a lecture about my own stupidity. And even by phone. What came out of this was almost a nervous breakdown. I called my husband, I couldn’t say a word, he quit work, rushed over, and spent the whole day running around with me like a child. Then all friends and acquaintances began calling all imaginable and inconceivable acquaintances through familiar radiologists, traumatologists, and gynecologists. Everyone unanimously says don’t be foolish (sorry for the unliterary style, but, as they say, you can’t erase words from a song), it’s okay to carry and give birth, with our ecology we receive so many negative factors and emotions every day that this can’t possibly happen will affect the child. That is, it can, of course, but not to such an extent as to take radical measures. Radiologists even give chilling examples that before, when there was no ultrasound, they took an X-ray of the fetus and gave birth to nothing. I really, really want to believe this. Friends advised me (my head is no longer thinking well) to look on the Internet to see if there was any information on my question; I found some sites that gave answers to questions similar to my problem, but they were very ambiguous. And suddenly inspiration! Remembering you, I found your website (simply super!!!) and address online and decided to try my luck again. I value and trust your opinion very much, and I will be very grateful if you take the time to answer. Today is 14 days late. The very word abortion fills me with wild horror. What about the vacuum? DON'T WANT!!! But if you still have to, then the deadlines are running out.
Please help me. I hope very much for your help. Thank you in advance, best regards, Julia.
Julia, hello!
GIVE BIRTH TO YOUR HEALTH, what is there to argue about? I don’t see any reason to panic, believe me, a mother’s emotional stress is more dangerous for the fetus than radiation! By the way, do you have a new book? Re-read the epigraph to the pregnancy chapter every day. I'll tell you one story. When I was still a student working as a nurse in the intensive care unit, a friend, quite elderly (as it seemed to me then, was a woman) came to see the doctor (woman) with her granddaughter - a charming girl of about five (blonde with blue eyes and huge bows). After leaving, the doctor told me that this woman, at 49 years old, was diagnosed with uterine cancer and, given the very rapid growth of the tumor, treatment began with radiation, and after 10 sessions it turned out that it was not cancer at all, but pregnancy - a rare case, since I haven't had a period since I was 47. Those. It was not a granddaughter, but a daughter. I saw this child with my own eyes... Good luck and health, and thank you for your kind words.
In the majority cases ovaries retain functions if they have been shifted at least 3 cm from the upper edge of the irradiation field. The radiation dose that the ovaries receive after transposition is calculated. It is known that when treating cervical cancer with radiation at a dose of 4000 cGy, ovaries shifted 3 cm from the edge of the radiation field receive a dose of 280 cGy, and those beyond the edge of the field by 4 cm receive 200 cGy of scattered radiation.
In one of research it has been demonstrated that the ovaries retain function when repositioned above the iliac crest.
It was estimated that approximately 80% women who underwent laparoscopic ovarian transposition retained ovarian function after various types of radiation therapy. The majority of women with stages I and II Hodgkin's disease who received radiation therapy alone or in combination with minimal chemotherapy after laparoscopic ovarian transposition retained ovarian function and fertility.
Clinical cases of unsuccessful ovarian transposition. Premature ovarian failure after transposition can be due to various reasons. This can happen if the ovaries have not been moved far enough outside the radiation field. Another reason for treatment failure may be that the ovaries migrate back to their normal location. This can happen when using absorbable suture material.
Ovarian failure after transpositions may also be due to disruption after surgery or radiation injury to the vascular pedicle. In other cases, functional cysts form. The mechanism of cyst formation is unknown, but their formation can be suppressed by the administration of oral contraceptives.
Fertility after radiation therapy. Pregnancy can occur after radiation therapy, regardless of the transposition of the ovaries performed before treatment. According to a study of 37 women, pregnancy occurred in 15% of patients with clear cell cancer of the vagina or cervix after close-focus radiation therapy with or without additional external irradiation and in 80% of patients after external irradiation for dysgerminoma and sarcoma of the pelvic organs. Interestingly, 75% of pregnancies occurred without ovarian reposition.
Pregnancy rate after radiotherapy. A number of studies have examined the incidence of pregnancy after radiation therapy to the pelvic area. In a study of 31,150 atomic bomb survivors, there was no increase in stillbirth rates, significant congenital deformities, chromosomal abnormalities, or mutations.
Similarly, in women, receiving chemotherapy with radiation therapy in Hodgkin's disease, there was also no increase in the incidence of stillbirths, low birth weight babies, congenital deformities, abnormal karyotype or cancer. However, one study found an increase in the incidence of low birth weight babies and spontaneous miscarriages if conception occurred less than 1 year after exposure to radiation. On this basis, it can be recommended to postpone pregnancy for 1 year after the end of radiation therapy.
Now medicine makes it possible to prevent problems such as infertility. One of the main side effects of antitumor therapy is its negative impact on the male reproductive system. Oncologists advise storing sperm before treatment to protect yourself from possible infertility as a result of toxic treatment. Advances in cancer therapy give patients with a similar diagnosis a chance for a new life.
Cancer is no longer a scary diagnosis. Modern methods of antitumor treatment (chemotherapy and radiation therapy) allow the patient to cope with the disease and return to a full life after treatment.
For men, the most common tumors are:
- trachea, bronchi, lung - 18.4%
- prostate gland - 12.9%
- skin - 11.4%
- stomach - 8.6%
- colon - 5.9%
- lymphatic and circulatory tissue – 4.8%
Favorable treatment prognosis*
* with timely detection of the disease
Negative consequences of oncology treatment
The survival rate for malignant neoplasms has increased significantly in recent years. In Russia, it grows annually by 4.4% according to WHO. But aggressive cancer treatment has side effects. Basic consequences of chemotherapy and radiation therapy:
- hair loss
- anemia
- change in appetite
- temporary or permanent infertility
- nausea and vomiting
- skin and nail changes
- weakness
- bleeding disorder
- infectious complications
Unfortunately, the average age of cancer patients in Russia decreases every year. Today, among cancer patients, a significant proportion are men and women of reproductive age: 20-40 years. Many of them are concerned with the question: What are the consequences of a malignant disease and how does chemotherapy treatment affect the ability to have children in the future? Not many people think about these consequences before starting antitumor treatment. It is important to remember that among the main consequences of chemotherapy- its negative impact on the male reproductive system:
Sperm suppression
Damage to the genetic apparatus of germ cells
Sperm suppression.
Under the influence of chemotherapy, there is a significant reduction in sperm, as well as a deterioration in their motility. Thus, the quality of the reproductive material decreases, which ultimately leads to infertility. Men who plan to become fathers after treatment may experience great difficulty conceiving.
Damage to the genetic apparatus.
You should discuss the possibility of infertility after chemotherapy with your doctor in advance. It has been proven that some toxic drugs cause genetic changes in germ cells. In the future, these disorders can be transmitted to the child during conception. Particularly negative on a man's ability to have children in the future influenced by drugs used for chemotherapy, such as cyclophosphamide and cisplatin.
Radiation therapy can subsequently lead to infertility. Irradiation sharply reduces the level of sperm motility. With a dose of no more than 0.7 g, complete restoration of spermatogenesis occurs after 1.5-2 years. With total irradiation of the entire body, fertility is not restored.
Particular attention to the negative consequences of chemotherapy and radiation therapy in the treatment of oncology should be paid to men with cancer of the reproductive organs: testicular seminoma, prostate tumors, penis. And if a man is still planning to become a father, it is important to think about the consequences of antitumor therapy in advance.
The high toxicity of radiation and chemotherapy leads* to:
*Using the example of Hodgkin's lymphoma
How to avoid infertility after cancer treatment
In recent decades, medicine has stepped forward - modern technologies make it possible to prevent such consequences of chemotherapy. Nowadays, sperm cryopreservation is a generally accepted method of preserving fertility in men with malignant neoplasms, allowing them to have children in the future.
An important condition for ensuring the success of cryopreservation is freezing sperm before treatment, since cell quality and DNA integrity can be impaired even after a single course of antitumor therapy. But doctors recommend resorting to cryopreservation even after starting radiation or chemotherapy. Since with each subsequent course of treatment the quality of sperm will deteriorate, to avoid irreversible consequences It is extremely important to freeze it as early as possible.
You can use your frozen sperm at any time. There is no need to wait several years until spermatogenesis is completely restored. Conceive a child possible using the method IVF or insemination:
- With in vitro fertilization (IVF), the fusion of an egg and a sperm occurs in a laboratory “in vitro”. As a result, an embryo is formed, which after 2 - 6 days is implanted into the woman’s uterus, where the fetus attaches and begins to develop. Thus, pregnancy occurs. Conception using IVF is a modern, proven method of assisted reproductive technology. Such a pregnancy is no different from a natural one.
- Artificial insemination is a more economical, but also less effective way of conception. During insemination, sperm is artificially introduced into the woman's uterine cavity.
Freezing sperm is a reliable way to preserve male fertility and has several advantages:
- Frozen sperm can be used at any time and delivered to any clinic at the right time
- Children born using stored sperm are no different from those conceived naturally
- The shelf life of frozen sperm is unlimited. There are known cases of children being born using sperm stored for more than 20 years.
- The quality of reproductive cells does not change in any way throughout the entire storage period.
Beating cancer is never easy. Chemotherapy or radiation attacks both the tumor and healthy cells.
Quite often the reproductive system suffers. However, modern medicine, when fighting cancer, tries not only to remove the threat to life, but also to eliminate the negative consequences. Therefore, you should not give up: the opportunity to have a child remains.
Is it possible to preserve fertility?
The answer to this question depends on many factors. Reproductive medicine offers several options depending on the following factors:
- at what age the patient suffers the disease;
- what is the nature of cancer;
- at what stage it was discovered;
- Is the tumor hormone dependent?
It often happens that a person, faced with a terrible diagnosis, does not think about procreation in the distant future, because the need to recover comes to the fore. The problem will be updated in the future. Many types of cancer are now considered curable. When the disease goes into remission, many may think about having children.
Doctors believe that it is necessary to think about this issue in advance. But a lot depends on the patient. If there is a risk of irreversible damage to reproductive function, you can protect yourself and take the necessary measures carefully.
What can a woman do?
Modern medicine offers women protection only during radiation therapy. During radiation sessions, the abdominal area is covered with special screens. In addition, the desired result can be achieved by moving the ovaries from the irradiation area. This is a laparoscopic surgery performed on an outpatient basis. The ovaries are separated from the fallopian tubes and fixed behind the uterus or in another area. At the same time, it is important to preserve the blood supply to the organs.
If a woman is undergoing chemotherapy, such manipulations will not bring any effect. A protective effect may come from temporary inhibition of ovarian function.
An effective way is to freeze the biomaterial in advance:
- Ovules. A procedure similar to that carried out before IVF. The greater the patient's ovarian reserve, the more eggs she can preserve. After recovery, she will be implanted with her own egg, fertilized with the sperm of a partner or an anonymous donor.
- Embryos. If the patient already has a partner, the embryos can be grown and preserved immediately.
- Ovarian tissue. This experimental technique is effective in young patients and is allowed only in the absence of metastases in the ovaries. In the future, follicles will be obtained from this tissue in the laboratory.
If the tumor directly affects the ovaries, the only solution may be to use donor oocytes.
Whatever measure is taken, the fertility specialist must take into account the recommendations of the oncologist. Women whose tumors were hormone-dependent are at greater risk. They can only be allowed. After all, hormonal stimulation can cause a recurrence of cancer.
Is the embryo healthy?
Expectant mothers who have overcome cancer are concerned about the health of such children. Some suspect that if the egg was taken from a body already affected by cancer, it is also sick to some extent.
There is no need to be afraid of this. At its core, cancer is an abnormally dividing epithelium. But the egg is a different type of cell and cannot be affected by a tumor.
As for the risk of inheriting the disease, it exists only for certain types of cancer:
- ovaries;
- endometrium;
- mammary gland;
- stomach;
- large intestine;
- lung
Sometimes familial diseases include acute leukemia and melanoma. But cancer is not directly inherited; children may inherit only a slightly higher risk of the disease than average. Whether this risk is realized or not is impossible to answer in advance.
What can a man do?
Cancer and its treatment also have a negative impact on the male reproductive system. The strong half of humanity suffers from testicles. During radiation therapy, they, like the female ovaries, are protected using shields that reduce the radiation dose. Unfortunately, no methods have been invented to protect male reproductive function from the effects of chemotherapy. However, medicine is making developments in this direction.
When cancer is detected, young people are strongly advised to preserve their biomaterial for the future. This can be done by freezing sperm or testicular tissue (obtained by biopsy), from which sperm can later be extracted for IVF.
Testicular tissue is more susceptible to damage from radiation and chemotherapy than ovarian tissue. Therefore, men are not advised to rely entirely on possible protective measures to ensure their ability to have children in the future.
Thus, cancer is not an obstacle to having children in the future. The main thing is to provide for all possible scenarios and protect yourself as much as possible.
The effect of radiation therapy on the possibility of bearing a fetus in the future depends on the type and location of the tumor, as well as on the dose of radiation received by the body.
The possibility of bearing and giving birth to a child may be affected by:
- · Irradiation uterus. If the purpose of radiotherapy was to treat a large tumor of the body or cervix, at the end of treatment the organ itself may be so deformed that pregnancy cannot develop.
- · Irradiation ovaries. As mentioned earlier, with tumor or radiation damage to the ovaries, the production of female sex hormones may be disrupted, as a result of which a woman will not be able to become pregnant and/or bear a fetus on her own. At the same time, hormone replacement therapy can help solve this problem.
- · Irradiation small pelvis Irradiation of a tumor that is not associated with the uterus or ovaries, but is located in the pelvic cavity, can also create difficulties when planning a pregnancy in the future. The fact is that as a result of radiation exposure, the mucous membrane of the fallopian tubes can be damaged. As a result of this, the process of fertilization of an egg (female reproductive cell) with a sperm (male reproductive cell) will become impossible. The problem can be solved by in vitro fertilization, during which germ cells are combined in a laboratory outside the woman’s body and then placed in her uterus, where they continue to develop.
- · Irradiation heads. When irradiating the head, the pituitary gland may be damaged, which will disrupt the hormonal activity of the ovaries and other glands of the body. You can also try to solve the problem with hormone replacement therapy.
- · Violation work vital organs And systems If during radiation therapy the functions of the heart were impaired or the lungs were damaged (for example, severe fibrosis developed), the woman may have difficulties during pregnancy. The fact is that during pregnancy (especially in the 3rd trimester), the load on the cardiovascular and respiratory system of the expectant mother increases significantly, which, in the presence of severe concomitant diseases, can cause the development of dangerous complications. Such women should be constantly monitored by an obstetrician-gynecologist and take supportive therapy. They are also not recommended to give birth through the vaginal canal (the method of choice is cesarean section delivery at 36 - 37 weeks of pregnancy).
It is also worth noting that the time elapsed from the end of radiation therapy to the onset of pregnancy is of no small importance. The fact is that the tumor itself, as well as the treatment carried out, significantly deplete the female body, as a result of which it needs time to restore energy reserves. That is why it is recommended to plan pregnancy no earlier than six months after treatment and only in the absence of signs of metastasis or relapse (re-development) of cancer.
