Cancer and cancer treatment may cause fertility problems. This will depend on the age of the patient, the type of cancer and the treatment received. Infertility can range from difficulty having a child to the inability to have a child. Infertility after treatment may be temporary, lasting months to years, or permanent (AYA Cancer Fertility Preservation Guidance Working Group 2014).

Patients need to be advised about and potentially referred for discussion about fertility preservation before starting treatment and need advice about contraception before, during and after treatment. Patients and their family should be aware of the ongoing costs involved in optimising fertility. Fertility management may apply in both men and women. Fertility preservation options are different for men and women and the need for ongoing contraception applies to both men and women.

A diagnosis of colorectal cancer in reproductive-age women may carry a risk of future infertility. Therefore, the risk of infertility, and fertility preservation options, both before and after cancer therapy, should be discussed with patients and their families as part of the initial cancer management planning. This discussion should be ongoing, with firm follow-up arrangements put into place. All discussions should be documented in the patient’s medical record.

Treatment for colorectal cancer may reduce female fertility through damage to the ovaries (from chemotherapy or radiation), damage to the uterus (from radiation) and potentially through damage to the fallopian tubes from abdominal surgery. Chemotherapy, especially with alkylating agents, is likely to reduce ovarian reserve, leading to a reduced fertility window or premature menopause. The type of chemotherapy will determine the extent of infertility associated with follicle loss. Radiation of the pelvis commonly induces permanent ovarian failure and may damage the uterus such that future pregnancy confers risk to the mother and fetus.

Pelvic radiation may also induce vaginal adhesions or stenosis, limiting future sexual activity. This risk can be reduced by using vaginal cylinders and topical oestrogen treatment.

Fertility preservation interventions including egg or embryo freezing and ovarian tissue cryopreservation offer realistic options for having a family, although sometimes egg donation and surrogacy may ultimately be required. Women of reproductive age who are concerned about future fertility should be referred to a fertility specialist to discuss potential fertility preservation interventions. Women with early menopause due to colorectal cancer treatment should be offered hormone replacement therapy and (if possible) managed by a menopause specialist.

Some colorectal cancers may be associated with a genetic risk, and specific gene testing in IVF embryos may reduce transmission risk. Some gastrointestinal cancers may be associated with a high risk of other cancers including uterine cancers. Careful counselling and surveillance are required, especially if future pregnancy is a consideration.

An early, collaborative and multidisciplinary approach with the Medical Services Advisory Committee and the surgical, oncology and fertility preservation teams will maximise the opportunity for best practice care and consideration for future fertility for young women diagnosed with colorectal cancer.

See the Cancer Council website for more information.