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Cervical Cancer and Infertility
Cervical cancer does not necessarily mean that you will become infertile but the odds are extremely high. This is not an easy concept to come to terms with, even for women who have gone through menopause or who have made up their minds to never have children. The enforced, involuntary removal of the womb is a very final act beyond which there is no going back. The ability to decide for oneself is taken away. It may even feel as though one’s womanhood is being stolen, especially if one’s identity is bound more in one’s physicality than one’s spiritual and psychological being. Many women find that if they allow themselves to grieve, as for the death of a loved one, it helps them to make sense of the loss and to integrate the experience into their sense of self.
Some pre-cancer treatments can adversely affect your fertility, the cone biopsy for example. There is a small chance that the cervix can close very tightly after a cone biopsy procedure, so tightly that sperm isn’t able to enter it. This condition is known as cervical stenosis. If you are still able to menstruate after the cone biopsy then you don’t have complete cervical stenosis, if the womb lining can get out, sperm can get in. Women who have had cone biopsies are also more likely to give birth before 37 weeks, their babies are more likely to have a low birth weight and they are more likely to give birth by caesarian section. The increased risk of early birth is because the cone biopsy weakens the cervix, which is really a muscle that keeps the entrance to the womb closed. If the cervix has been weakened, the weight of the baby pressing down on the cervix may cause it to open too soon and induce labour. This can be prevented by your doctor giving you a “running stitch” to hold it shut. Your doctor may be more technical and call it a purse string suture; the suture is cut before you go into labour, at around 37 weeks.
LLETZ stands for large loop excision of the transformation zone, and has roughly the same effects as cone biopsies i.e. early birth, low birth weight and increased caesarian sections. It is also more likely to rupture membranes. In a review it was revealed that the amount of cervical tissue removed had an impact on the risk of early birth etc. If the excision was more than 10mm deep then the risk for early birth increased. Laser therapy, cryotherapy and diathermy are unlikely to affect your fertility.
If you are already pregnant when the abnormal cells are discovered your doctor will not recommend a cone biopsy unless he or she suspects that there is cervical cancer. The biopsy could weaken the cervix and result in a miscarriage. You may, however, undergo a colposcopy. It’s perfectly safe and won’t affect your delivery, or your chances of falling pregnant again. Usually treatment for pre-cancerous cells is scheduled for after you’ve given birth, when you and the baby are out of danger.
When you actually have cancer and have to go for treatment your chances of infertility are increased as the treatment becomes more aggressive and invasive. Chemotherapy causes infertility although for some people the effects are only temporary. The permanence of chemo’s infertility depends on the drugs used, the dosages, whether a combination of drugs is used as a combination is more likely to result in infertility, the age of the patient and the general health of the patient. If you are still young and have your heart set on having children it may be possible to choose a chemotherapy that will least affect your fertility, but it also depends on the circumstances.
Radiotherapy is given directly to the affected area, so it would be aimed directly at the pelvic area and cervix. This can obviously lead to infertility and is more likely to be permanent. The risk is increased with the strength of the dose and the increased age of the patient. Total body irradiation will usually cause permanent infertility and only a very rare few will go on to have children afterwards.
Surgery to remove cancer does not generally affect fertility, however in the case of cervical cancer where it might be necessary to have the womb or ovaries removed, infertility is an inevitable consequence. Some types of surgery to the cervix, vagina and vulva also result in infertility.
Cervical cancer is not a death sentence; in fact it is one of the most curable cancers around. It is ironic, however, in that for many women it does mean the end of life, or at least the end of the continuation of life, the end of progeny. For many women this in itself is a death sentence. They need support and love to help them through this very difficult time and to enable them to see that they still have so much to offer the world. A woman can be a whole woman on her own terms and she can decide those terms for herself. Sometimes all she needs is a little help to be able to see that.
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