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A lot of people under the age of 45 years are diagnosed with cancer every year, and approximately one-half of these patients are women which mean they are women who are still in their reproductive age range.

Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Studies demonstrate that future fertility is a concern for many women diagnosed with cancer.

Cancer treatments including surgery, chemotherapy, and radiation can affect fertility by impacting several biologic systems. The neuroendocrine axis, the immature and growing follicles within the ovaries, and the reproductive organs necessary for a woman to carry a pregnancy to term may all be impacted by cancer treatment.

Today, fertility preservation is an option for girls and women facing a cancer diagnosis, and emerging research is providing clinicians with an increasing number of reproductive and hormonal management tools.

Early referral to either a gynecologist or reproductive endocrinologist is recommended to ensure that women are counseled about fertility preservation options. Physicians can play an important role in fertility by working closely with oncologists, providing patients with information about fertility preservation options prior to the start of cancer treatment, monitoring reproductive capacity after treatment, and working with cancer survivors to explore potential avenues to parenthood.

Speaking to our radiation oncologist Dr Pacifique Mugenzi he explained that a female is born with all the eggs she will have. As she moves through puberty, hormones allow mature eggs to be released every month during the menstrual cycle until the female reaches menopause and the hormonal cycles eventually stop.  Chemotherapy (chemo) works by killing cells in the body that are dividing quickly. The hormones, such as estrogen, needed to release eggs each month and prepare the uterus for a possible pregnancy are made in the cells of the ovaries (oocytes). Odocytes tend to divide quickly, so are often affected by chemo. This can lead to loss of those important hormones and can affect fertility. Sometimes a woman will go into premature or early menopause. Radiation treatments use high-energy rays to kill cancer cells. Radiation that's aimed at or around a woman’s reproductive organs can affect fertility. Dr Mugenzi however explained that some women are lucky enough to have their menstrual cycle back after chemotherapy and are able to have children after cancer treatment.

He further explained that in Rwanda egg preservation service is still not available to everyone and makes it harder for patients to access the services but all women are explained the stake before they start treatment and they sign a consent form if they decide to undergo treatment.

If you are fertile or think you might be fertile, it's very important to avoid getting pregnant during chemo. Many chemo drugs can hurt a developing fetus, causing birth defects or other harm. Some can contribute to having a miscarriage. Some women remain fertile during chemo, so it's best to use very effective birth control.  Remember, too, that some women can get pregnant even when their periods have stopped. For this reason, it’s important to use birth control whether or not you have periods, but talk to your cancer care team about what's best for your situation.