Women’s cancers and the impact on fertilityJuly 12, 2019
Being diagnosed with gynaecological cancer at any age can be life changing. For the vast majority, the medical care provided during diagnosis and treatment is fantastic. For most, the NHS provides excellent support for the patient and their family to understand what the cancer diagnosis means and what the next steps will be.
However, on the rare occasions when medical professionals are found to have let women down and a gynaecological cancer diagnosis is negligently delayed, there can be the most catastrophic consequences.
For women who suffer a delay in diagnosis of gynaecological cancer, the delay can mean the difference between being able to have children or not.
Read on for a summary of the types of treatment for gynaecological cancers, the impact those treatments can have on fertility and the fertility options available for women who, as a result of their cancer or the treatment required, cannot conceive naturally.
Gynaecological cancer treatments and impact on fertility
Treatment for cancer will depend on how advanced the cancer is when it is diagnosed. It is recognised that generally the earlier the cancer diagnosis, the better.
1. Pelvic chemoradiotherapy
Chemoradiotherapy is the combination of chemotherapy and radiotherapy to treat cancer.
Chemotherapy is a drug used to kill cancer cells by circulating the body, usually through a drip.
Radiotherapy destroys cancer cells either through high doses of radiation being beamed at the cancer cells through the skin or by way of a radioactive implant placed next to the cancer. This is particularly for cervical or vaginal cancer, and is called brachytherapy.
However, like many treatments, there are side effects. The chemoradiotherapy often damages healthy cells as well as destroying the cancerous ones.
Side effects from chemoradiotherapy include:
- Pelvic scarring and tissue damage including damage to the womb and ovaries leading to infertility;
- Bowel problems, diarrhoea and bloating;
- Bowel and bladder damage leading to incontinence;
- Pain when urinating, increased urinary frequency and urinary urgency;
- Scarring and narrowing of the vaginal diameter and length;
- If ovarian function has been affected, the vagina can become very dry which can cause pain during sexual intercourse and/or vaginal examinations;
- Pelvic insufficiency fractures as a result of bone weakness; and
- Leg swelling (lymphoedema) causing pain, effecting mobility and worsening quality of life.
Surgery is another treatment option for gynaecological cancer which often impacts on fertility. The type of surgery will of course depend on the type of cancer and the stage at which it is diagnosed. For many gynaecological cancers, surgery will involve removal of part or all of the reproductive organs.
For cervical cancer, if caught early enough, surgery can be offered to remove the cervix and cancerous tumour but the womb and ovaries can be left in place and unaffected. However, for many other cancers, such as womb cancer, a total hysterectomy (removal of the uterus) may be needed to treat the cancer.
Fertility options after cancer treatment
Any impact on fertility will be devastating and NHS funding and support for fertility treatments vary wildly depending on where you live in the country.
There are a number of options for fertility treatment following cancer treatment:
IVF with your own eggs
In vitro fertilisation (IVF) is a procedure to help people with fertility problems to have a baby. If your ovaries and womb have been unaffected by the cancer treatment, you may be able to have your eggs harvested and carry your own baby. After the eggs are harvested, they are either frozen or fertilised with your partner’s sperm in the IVF laboratory. Once the embryos are formed they can either be replaced in the womb or frozen to be used later.
IVF is sometimes available on the NHS but this depends on your age and where you live in the country. There are also normally restrictions to the number of times you can have IVF (success rates can vary depending on a variety of factors). The NHS does not usually pay for eggs or embryos to be frozen if you do not want to have a baby right away.
The cost of private IVF is likely to be £5,000 or more per cycle. It is also usually enormously stressful and physically draining.
IVF with donor eggs
If your ovaries have been affected by cancer treatment, you may not have eggs which can be harvested. You may therefore need to use eggs donated by other women in order to have a baby.
The donor woman would also go through IVF and the donor eggs would be fertilised in an IVF laboratory by your partner’s sperm. The embryo can then be transferred to your womb (provided your womb was unaffected by the cancer treatment).
Donor eggs, however, come at a price. This varies widely depending on the clinic you chose and the location in the country but will likely cost more than IVF with your own eggs.
In both IVF scenarios described above arising as a result of delayed diagnosis, private fertility treatment costs can usually be included in a medical negligence compensation claim.
If your womb has been affected by cancer treatment then you may not be able to carry your own children, even if your ovaries are able to produce eggs.
Surrogacy is when a woman agrees to become pregnant and have a baby for another person or couple. In England, you cannot buy a baby, and so the surrogate cannot charge a fee. However, you will need to pay for the surrogate’s reasonable expenses including travel costs, treatment costs (such as IVF and private obstetric medical treatment), maternity clothes, childcare costs, any loss of earnings and legal fees.
Surrogacy is very expensive and in the region of £30,000-£45,000 per child.
Getting support through your journey
Going through a cancer diagnosis and treatment can be an emotional rollercoaster. Receiving news that your fertility has been affected as a result often comes as a further devastating blow. The fertility options afterwards can be confusing and daunting.
If you have suffered a delay in diagnosis of cancer which has impacted on your fertility, a claim in compensation may help secure the money you need to explore your fertility options and continue your future plans.
There are local support groups with women who have been through similar experiences and many people find this helpful. Charities can offer help to support you through this stressful time. For example, the Eve Appeal is a charity which raises awareness and funds research for gynaecological cancers. They also provide support to those with cancer.
Olivia Boschat is a senior solicitor in the Medical Negligence team at Bolt Burdon Kemp. If you or a loved one has suffered an injury as a result of someone else’s negligence, contact Olivia in confidence on 020 7288 4868 or at email@example.com. Alternatively, complete this form and one of the solicitors in the Medical Negligence team will contact you. Find out more about the Medical Negligence team.
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