{"id":15453,"date":"2022-08-18T18:41:43","date_gmt":"2022-08-18T23:41:43","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=15453"},"modified":"2025-01-14T07:59:26","modified_gmt":"2025-01-14T13:59:26","slug":"retour-de-la-fertilite-apres-chimiotherapie","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/return-of-fertility-after-chemotherap\/","title":{"rendered":"Pouvez-vous surveiller votre fertilit\u00e9 pendant la chimioth\u00e9rapie \u00e0 l'aide de m\u00e9thodes de connaissance de la fertilit\u00e9, et la fertilit\u00e9 reviendra-t-elle apr\u00e8s la chimioth\u00e9rapie ?"},"content":{"rendered":"\n

When the unthinkable happens and a woman of childbearing age receives a cancer diagnosis, one of the countless questions she may have is whether she will be able to have any (or any more) children after undergoing chemotherapy. A 2012 study called infertility \u201cone of the main long-term consequences<\/em> of combination chemotherapy for lymphoma, leukemias, and other malignancies in young women\u201d [1] (emphasis added). And a 2019 study of Taiwanese women who underwent chemotherapy for breast cancer regrettably found that \u201cWomen with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility\u201d [2]. <\/p>\n\n\n\n

What is known (and unknown) about the possibility of fertility returning after completion of chemotherapy? For answers to this question and others, and at the recommendation of FACTS <\/a>founder Dr. Marguerite Duane, Natural Womanhood turned to Dr. Thomas Bouchard<\/a>. Dr. Bouchard is a Marquette Method medical consultant, and an associate professor at the University of Calgary. He has significant experience in both research<\/a> and<\/em> in-person clinical practice caring for family medicine and obstetrics patients, and has first-hand experience with a patient who successfully monitored her return to fertility post-chemotherapy treatment..   <\/p>\n\n\n\n

Why does chemotherapy make a woman (at least temporarily) infertile?<\/span><\/h2>\n\n\n\n

According to the National Cancer Institute<\/a>, \u201cChemotherapy<\/a> (especially alkylating agents<\/a>) can affect the ovaries<\/a>, causing them to stop releasing eggs and estrogen<\/a>.\u201d Another way chemo makes women infertile is by directly damaging their eggs. We\u2019re all familiar with the hair loss that accompanies cancer treatment, which is because chemo drugs work to kill rapidly dividing cells, including cancer cells and (unfortunately) cells in the hair roots and oocytes (eggs)–even if they\u2019re healthy. Chemo-induced infertility may be temporary or permanent, but is more likely to be permanent in women who are closer to menopause than it is in younger women. <\/p>\n\n\n\n

For reasons we will explain below, the various effects of chemotherapy on the reproductive system can render data from traditional biomarkers inaccurate (cervical mucus changes) or unusable (temperature readings, qualitative urinary hormone readings) during and immediately after treatment. However, as we will also discuss, there is hope that quantitative urinary hormone monitors may provide an opportunity for women to monitor and track their return to fertility after discontinuing chemotherapy treatment.  <\/p>\n\n\n\n

Why can\u2019t a woman on chemo use traditional cervical mucus or basal body temperature observations to track her fertility? <\/span><\/h2>\n\n\n\n

Throughout the interview with Natural Womanhood, Dr. Bouchard referenced a case study of a Marquette Method user who was diagnosed with breast cancer and started chemotherapy. <\/p>\n\n\n\n

Why mucus-based methods are unreliable for women on chemo<\/span><\/h3>\n\n\n\n

As we cover in greater detail here<\/a>, estrogen is primarily produced by the ovaries, and rising estrogen levels in the days immediately preceding ovulation stimulate production of clear, stretchy, egg white-appearing cervical mucus (EWCM). Women utilizing mucus-based FAMs track EWCM observations to know when they are fertile. But as Dr. Bouchard explained, the woman in the case study\u2019s estrogen levels never rose, and remained consistently low while she was on chemotherapy, thus making mucus changes based on estrogen changes unreliable. <\/p>\n\n\n\n

Why you can\u2019t use temperature observations to determine fertility during chemo<\/span><\/h3>\n\n\n\n

In addition to monitoring the mucus sign, symptothermal methods also utilize basal body temperature (BBT) observations<\/a> to determine that ovulation has occurred, since the progesterone rise after ovulation causes a noticeable rise in BBT. Unfortunately, these methods also won\u2019t work in women undergoing chemo, because as Dr. Bouchard explained, the lack of ovulation experienced by a woman undergoing chemo means there will be no progesterone rise, and \u201cshe\u2019s not going to get any temperature shift.\u201d <\/p>\n\n\n\n

Can you successfully use hormonal methods while undergoing chemo?<\/span><\/h2>\n\n\n\n

So, if symptom-based biomarkers like cervical mucus and BBT are unreliable (or nonexistent) for monitoring fertility while undergoing chemo, what about methods that utilize urinary hormone monitoring? Women may wonder, in particular, if the Marquette Method can be successfully utilized during chemotherapy to monitor their return to fertility. <\/p>\n\n\n\n

Why qualitative hormonal monitors like the ClearBlue fertility monitor are unreliable during and immediately after stopping chemo<\/span><\/h3>\n\n\n\n

In order to identify whether she was fertile or not while on chemo, and then to determine when her fertility returned after stopping chemo, the patient in Dr. Bouchard\u2019s case study originally used the ClearBlue fertility monitor (CBFM), which tests urinary hormone levels of luteinizing hormone (LH) and provides \u2018low,\u2019 \u2018high,\u2019 or \u2018peak\u2019 fertility readings. <\/p>\n\n\n\n

But the woman in the case study had \u201chigh\u201d readings every day she tested using the CBFM, which could never naturally occur, and was a direct result of the chemotherapy. Normally, LH surges immediately before ovulation, and then rapidly decreases again; the CBFM tests estrogen and LH in the urine to identify when this happens. But CBFMs give only a qualitative reading (low, high or peak) for LH levels. <\/p>\n\n\n\n

Dr. Bouchard shared, \u201cWhen you\u2019re talking about traditional methods that use mucus or temperature, you\u2019re not going to be able to get accurate results mainly because when estrogen and LH levels are fluctuating – and in the case study the woman\u2019s LH levels were consistently high- there is no pattern of fertility that can be discerned.\u201d He continued, \u201cLH is something that surges in a very narrow window for a few days and then goes right back down\u2026persistently high LH over many days is not what happens physiologically in a normal cycle, so it was clearly related to the chemotherapy.\u201d <\/p>\n\n\n\n

Why you may want to consider using a quantitative hormonal monitor (i.e., the Mira monitor) instead<\/span><\/h3>\n\n\n\n

When the chemotherapy case study patient consulted Dr. Bouchard, he recommended that she switch to the Mira quantitative urinary hormone monitor<\/a> because it gives actual numbers of both estrogen and LH levels, rather than qualitative \u201clow,\u201d \u201chigh,\u201d or \u201cpeak\u201d readings. Dr. Bouchard previously conducted research<\/a> published last fall (the full text of which was provided to Natural Womanhood for review), proving that the Mira monitor can accurately and reliably determine the fertile window in normal, healthy women, when compared to the CBFM (which was itself previously validated by research) [3][4]. <\/p>\n\n\n\n

After consulting with Dr. Bouchard, the patient began utilizing the Mira monitor. To use the monitor to track her fertility, she used a personalized protocol developed by Dr. Bouchard, which blended Mira monitor readings with a version of a question from the Two-Day Method, which required the patient to ask herself the daily question \u201cWas my estrogen level over 100 (ng\/mL) yesterday or today?\u201d If the answer was \u2018yes,\u2019 she would abstain. If the level was under 100,  \u201cthat was an available day [for intercourse].\u201d Says Dr. Bouchard: \u201cThat protocol did work for her, and she was able to follow that all the way through until she stopped chemo and started cycling again.\u201d <\/p>\n\n\n\n

Of the patient\u2019s experience with the monitor, Dr. Bouchard noted \u201cto see that persistently high LH tells you that she\u2019s not ovulatory, the ovulatory mechanism is disrupted.\u201d But, he added, \u201cwhen she stopped the chemotherapeutic agents, her LH levels started to drop, and her estrogen started to rise, and within a month she resumed a normal physiologic state where she was able to ovulate and we were able to see a normal cycle and a normal period after that.\u201d <\/p>\n\n\n\n

Dr. Bouchard observed, \u201cThis is the first case of a woman using chemotherapy that has been tracked with quantitative hormones that I\u2019m aware of. There\u2019s never been the ability before to track the hormones in a quantitative way to get the data that we got from this particular case. So this is brand-new information.\u201d (Dr. Bouchard recommended any woman who wants to use fertility awareness after receiving a cancer diagnosis requiring chemo contact a Marquette Method instructor, who can in turn get in touch with him.)<\/p>\n\n\n\n

What factors influence whether fertility will return?<\/span><\/h2>\n\n\n\n

While Dr. Bouchard\u2019s case study is encouraging, as we mentioned above, not all women will regain their fertility post-chemotherapy. Unfortunately, for some women, chemo will render them permanently infertile. <\/p>\n\n\n\n

The two biggest factors impacting whether a woman\u2019s fertility will return after stopping chemotherapy are her age (the younger she is, the more likely her fertility will return) and the type of chemotherapy she received (more on types associated with long-term infertility is here<\/a>). Rather than anticipating infertility due to chemo, Dr. Bouchard believes \u201cYou would expect fertility to return, depending on [the woman\u2019s] age. However, he notes, \u201d\u201cpeople who are not aware of their natural fertility are not necessarily tracking or following this closely.\u201d <\/p>\n\n\n\n

Additionally, he pointed out, women receive a cocktail or combination of multiple drugs for chemotherapy; chemo is not one specific drug. As a result, every woman is different, and thus different women\u2019s chances of fertility returning will vary. \u201cThis is not something where we can generalize about chemo, it really depends on the chemo agent they\u2019re using.\u201d <\/p>\n\n\n\n

Of note, while the woman in the case study experienced a return of fertility within one month after chemo ended, women are often counseled<\/a> to wait a minimum of six months after stopping chemo before trying to conceive to ensure that any eggs damaged by the chemo medications are no longer in the body. Like the woman in the case study, women seeking to avoid pregnancy after chemo could conceivably work with their healthcare provider to determine when they could have intercourse based on Mira monitor (or other monitor that gives quantitative- specific numbers rather than a \u2018high\u2019 or \u2018low\u2019 result) readings. <\/p>\n\n\n\n

When it comes to chemo\u2019s effects on fertility, more research is needed<\/span><\/h2>\n\n\n\n

In addition to its usefulness for women undergoing or post-chemotherapy, Dr. Bouchard sees great value in having the advanced hormonal analysis offered by quantitative data monitors like Mira. Women who may especially benefit from the more granular detail offered by quantitative monitors may include: postpartum women, women who generally have low LH such that the CBFM doesn\u2019t detect the levels, women who are approaching menopause, and women who have PCOS, to name a few. <\/p>\n\n\n\n

Of course, the case report discussed here is only the starting point. \u201cGoing forward, case reports and case series in NFP are really important to share. The more data we can collect, the more we can share ideas\u201d to benefit women, says Dr. Bouchard. He values what he calls \u201ccrowd-sourced research;\u201d \u201cthere are so many NFP users who are collecting data, and having a way to get the data from the users to the researcher to put things together in a case series is what we need to do. And that requires crosstalk from methods, and users, and people interested in this topic.\u201d <\/p>\n\n\n\n

Note: Dr. Bouchard reported no financial interests to disclose. <\/p>\n\n\n\n

References: <\/em><\/p>\n\n\n\n[1] Blumenfeld, Zeev. \u201cChemotherapy and fertility.\u201d Best practice & research. Clinical obstetrics & gynaecology<\/em> vol. 26, no. 3 (2012): pp. 379-90. doi:10.1016\/j.bpobgyn.2011.11.008<\/p>\n\n\n\n[2] Huang, Sheng-Miauh et al. \u201cInfertility-related knowledge in childbearing-age women with breast cancer after chemotherapy.\u201d International journal of nursing practice<\/em> vol. 25, no. 5 (2019): e12765. doi:10.1111\/ijn.12765<\/p>\n\n\n\n[3] Bouchard, Thomas P et al. \u201cQuantitative versus qualitative estrogen and luteinizing hormone testing for personal fertility monitoring.\u201d Expert review of molecular diagnostics<\/em> vol. 21, no. 12 (2021): pp. 1349-60. doi:10.1080\/14737159.2021.2000393<\/p>\n\n\n\n[4] Behre, H M et al. \u201cPrediction of ovulation by urinary hormone measurements with the home use ClearPlan Fertility Monitor: comparison with transvaginal ultrasound scans and serum hormone measurements.\u201d Human reproduction (Oxford, England)<\/em> vol. 15, no. 12 (2000): pp. 2478-82. doi:10.1093\/humrep\/15.12.2478 <\/p>\n\n\n\n

Additional Reading:<\/p>\n\n\n\n

Hormonal contraceptives increase breast cancer risk: a doctor’s report on why<\/a><\/p>\n\n\n\n

Ovarian tissue freezing: a better way to potentially preserve fertility in women facing cancer treatment<\/a><\/p>\n\n\n\n

<\/p>\n\n\n\n

<\/span><\/h2>\n\n\n\n

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