Women who receive a bowel cancer diagnosis before beginning or completing their families will often have many questions about how cancer treatment will affect their ability to have children in the future.
Many women diagnosed with cancer during their childbearing years will be able to have children naturally after treatment, but some are at risk of losing their ability to conceive a child or carry a pregnancy.
Surgery that involves removal of the uterus and/or both ovaries in women will cause infertility. In addition, it may cause scarring that can make it difficult to conceive.
Radiation treatment to the pelvic area also damages the ovaries, which are very sensitive to even low doses of radiation. The amount of damage depends on the size of the radiation field, the dose of radiation given and the number of treatments. If the uterus is included in the radiation field, it can be damaged, making it difficult for a woman to conceive and carry a pregnancy.
Chemotherapy can cause temporary or permanent infertility, depending on the drugs and doses used. Your periods may become irregular or stop during treatment. The younger you are, the more likely you are to carry on having monthly periods. If the infertility is temporary, your periods may return six months to a year later. If the infertility is permanent, you may go through menopause and your periods will stop.
The newer biological therapies may affect your fertility, depending on which drug you are having. Speak to your oncologist if you are worried about this.
Your fertility options will depend on how much time you have before your cancer treatment starts and how well you are. The chances of having a baby after fertility treatment vary from person to person. Your fertility specialist can give you an idea of how successful the different fertility treatment options are likely to be.
If you have a partner, you may be able to have your eggs fertilised using in vitro fertilisation (IVF). This will take two to four weeks once you have been referred to a fertility specialist. The embryos can then be frozen and used once you are ready to start a family.
If you don’t have a partner, you may be able to store unfertilised eggs, which you can use in future fertility treatment. This procedure is less likely to result in a pregnancy than using frozen embryos. Some women use donated sperm so they can freeze embryos, rather than eggs.
If there isn’t time to freeze embryos or eggs before your treatment starts, you may be able to freeze tissue from one of your ovaries.
The storage of ovarian tissue and its use in fertility treatments is still fairly new. Your fertility specialist will be able to tell you about this and other possible treatments, if you would like to know more.
Bowel Cancer Australia has put together some helpful information about how bowel cancer surgery and treatment can affect reproductive health, what options exist to help preserve fertility before treatment begins, and what alternatives can be considered for building a family after treatment ends.
Diagnosed with bowel cancer at the age of 32, "have you thought about having children" was a question Marisa wasn't expecting to hear from her treating doctor.
Now two years post-treatment, Marisa shares her kick ass story to help raise awareness of bowel cancer in women, and to help other women better understand how bowel cancer treatments can affect reproductive health and the preservation options available.
However, in an effort to raise awareness, Marissa now also often writes about her diagnosis with bowel cancer, at the age of 32, and how it has affected her life.
“There is no glorifying what a scary and horrible disease cancer is,” Marisa said, “but I hope that by sharing my experience I can spread awareness and encourage others to learn more about bowel awareness, be aware of possible symptoms and realise that you're never too young to be affected by bowel cancer.”
As my doctor started talking about my treatment options, I was asked question I hadn't expected.
"Are you in a long term relationship and do you want to have children?"
While Jason and I have been together for 3.5 years and we had talked about having children 'someday', that was definitely not a day anytime soon!
I explained my situation and then she recommended I talk to a fertility doctor about options for getting my eggs or an embryo frozen, just to be safe, as the chemotherapy treatment can kill eggs and in some cases make a person infertile.
This had to be decided and done before any chemotherapy treatment started, which I was told had to commence no more than four weeks after my surgery date.
We were already bordering the two-week point, so I had to act fast!
She booked me in with the fertility nurse the next day so I could find out all my options.
I left the appointment in a daze, still trying to process everything the doctor had told me.
I looked at the report and nothing made any sense.
It was all in technical terms I didn't understand.
There was one word I understood and recognised. That word was Cancer.
It just so happened at the time of the appointment Jason had to fly to America for two weeks to do training for his new job, so my Mum came with me.
This made the decision process very simple because freezing an embryo was no longer an option since Jason would have to be back in the country by Friday to have it done and he wasn't returning until the following week.
So I made the decision in 20 minutes that I would have IVF to freeze my eggs.
It kind of frustrated me that I had to make such a quick decision on something I had honestly not given much thought about, but at times like this you just need to get the ball rolling and you don't have time to stall.
That afternoon I had an interview with a fertility nurse who went through everything.
She gave me a script to pick up my IVF medication that evening so I could commence the next day.
I went from saying yes to having my eggs harvested, to starting the injections, within 24 hours.
It almost happened so fast I didn't have time to think about it, which was probably a good thing.
If you have ever gone through the IVF process, you will know it is all about timing.
What injections you give yourself at what time, how many you need to do.
Going for blood tests and ultrasounds every two days to ensure you are on track and your follicles are developing as they should.
Then the timing of that last needle before you have to go in to get your eggs removed and harvested.
It was quite a hard time, not only with Jason being away but because I was giving myself these hormones and still taking my pain medication which made me feel like I was on an emotional roller coaster ride where my moods were up and down and all over the place.
Definitely not the head space you want to be in at a time like this, but I would never want to have regrets, so I knew IVF was the right thing to do.
I began to get quite frustrated because this was not a decision I thought I would have to make and here I was undergoing fertility treatment at a time in my life when I didn't even want children.
I wasn't in the head space to consider a family and knew it was something we didn't want for quite some time, so it was a very different experience compared to someone who has IVF because they WANT a baby.
It is hard to explain but I almost didn't feel like I had a choice.
The week went by surprisingly fast and it was time for me to go in to harvest. I know a few people who have undergone IVF and on average they had got about 5-6 eggs so I was hopeful it would be the same for me.
I was beyond devastated and I tried to hold back tears, as I watched the procedure and saw them only able to retrieve two eggs.
My Mum held my hand and told me not to be sad and that I had two good, 32 year old eggs.
They wheeled me back into the next room where I could get changed in a one of the cubicles separated by curtains.
When I heard the girl in the cubicle next to me say they retrieved eight eggs I broke down.
I felt so defeated and disappointed.
What was wrong with me?
Why couldn't I at least have 5 eggs like everyone else I knew.
The fertility counsellor came in to see me and said it was very normal to feel these emotions and that even though I was sad given everything my body had gone through, I was lucky to even get two.
I hadn't thought about it like that, but in that moment nothing anyone said or did was going to make me feel better about my two eggs.
I headed home still feeling down and just had a quiet night.
I had my first appointment with my oncologist in a couple of days so I tried to busy myself until that time came."