FERTILITY & FAMILY PLANNING WITH MELANOMA & SKIN CANCER
As survival rates rise among young cancer patients, so does the importance of discussing fertility preservation and family planning with healthcare providers. As you navigate your cancer journey, you may have questions about how treatment can impact your fertility. To support you in these conversations with your healthcare team, we’ve compiled information to provide guidance on this crucial topic.
Please note that we are referring to fertility as the following depending on your gender assigned at birth: Sperm count, sperm quality (motility, morphology and DNA integrity). Egg viability, ovarian reserve, uterine (womb) integrity, ability to conceive and give birth to healthy children.
Speak to your healthcare team as early as possible in your cancer journey. It is important to inform your healthcare team of your wish to have children as early as possible in your diagnosis, so they can make personalized recommendations for you. This will also help you make informed treatment decisions and receive timely access to fertility care.
How could treatments affect fertility?
As advancements in melanoma and skin cancer treatments continue, immunotherapy and targeted therapy continue to expand, the long-term effects on fertility are still being studied and much is still unknown. If you have been given or are just starting your treatment with one of these drugs as part of your melanoma or skin cancer treatment, talk to your healthcare team about how these treatments may affect your fertility.
Fertility advice according to melanoma stage
Stage 0-I
If you have melanoma, at an early stage that has not spread and can be removed completely by surgery (either stage 0, melanoma in situ) or stage 1, localized melanoma), this is unlikely to affect your fertility. Whilst some research studies indicate that pregnancy rates amongst those recovering from cancer are often lower than control populations (people unaffected by cancer), this does not apply to those who have had early stage melanoma. This is likely due to the fact the treatment is minor surgery, with no treatments that affect the body as a whole.1
Stage II
At Stage 2, the melanoma has not spread beyond the original site, but there is a risk it may do so in the future. If you are diagnosed with a stage 2 melanoma, you may require a procedure called a sentinel lymph node biopsy (SLNB) to determine whether the melanoma has spread to nearby lymph nodes. Learn more about SLNB. If you are diagnosed with a stage 2B or 2C melanoma, you may be offered additional adjuvant treatments, including immunotherapy.
The blue dyes and radioactive tracers used for sentinel lymph node biopsy (SLNB) are very unlikely to affect your fertility because the doses are very low. However, these are not recommended if you are pregnant. Some reports suggest these agents have little impact on the baby, but this hasn’t been well-studied in many pregnant women. If your medical team recommends a SLNB , it’s a good idea to talk about the timing and whether it’s safe to wait until after you have your baby.1
Stage III
If you are diagnosed with stage 3 melanoma (with a positive SLNB and spread to lymph nodes) you may be offered adjuvant treatments, including immunotherapy and targeted therapies. As advancements in melanoma and skin cancer treatments continue, immunotherapy and targeted therapy continue to expand, the long-term effects on fertility are still being studied and much is still unknown. If you have been given or are just starting your treatment with one of these drugs as part of your melanoma or skin cancer treatment, talk to your healthcare team about how these treatments may affect your fertility.1
Stage IV
Patients with active stage 4 melanoma are advised not to conceive or father a child during treatment, both because of the effects of the treatments and because of the serious nature of stage 4 melanoma. Patients diagnosed with stage 4 melanoma are not routinely offered fertility preservation as it is often important for treatment to start quickly, and fertility treatment could delay this.1
Treatment Side Effects
Fertility Preservation options
Fertility Preservation Options (Male)
- Sperm banking
- Testicular tissue banking (prepubertal)
- Protect testicles from treatment/radiation
- Do nothing, with option of donor sperm in the future if infertile
Fertility Preservation Options (Female)
- In Vitro fertilization (IVF) to cryopreserve oocytes or embryos
- In Vitro Maturation (IVM) to cryopreserve oocytes or embryos
- Protect ovaries from treatment
- Freeze ovarian tissue
- Do nothing, with option of egg donor in the future if infertile
When is it safe to try and conceive?
Recommendations have suggested a minimum of 4-5 months post treatment with immunotherapy for females. This is due to the PD-1 and PD-L1 pathway playing a central role in fetomaternal tolerance, inhibition of the pathway is associated with miscarriage.
Pregnancy After Melanoma
When looking at pregnancy after melanoma and considering the risk of recurrence within the first 2-3 years post diagnosis being the highest, patients who are Stage IIb, IIc or III should likely wait until after this window to think about conceiving. It can be important to review that melanoma can have estrogen and progesterone receptors, it is also known that nevi (mole) pigmentation can change in pregnancy. Pregnancy can also be thought of as a “state of immunosuppression” that could allow for tumour progression. Based on literature, women who had a subsequent pregnancy post melanoma treatment do not have an increased risk of recurrence. * With advancements in treatments, increased numbers of people diagnosed with stage 4 melanoma are surviving with no evidence of active melanoma. If this applies to you, and you wish to start or expand your family, discuss this openly with your healthcare team who can guide you regarding the timing of this, and how best to monitor you during your pregnancy.
Questions to ask your doctor that can help start the conversation:
1. How will my cancer and cancer treatment affect my fertility?
2. Based on my treatment plan, what is my risk of infertility [high, moderate, low]?
3. What are my options for fertility preservation before I begin cancer treatment?
4. Can you refer me to a fertility preservation specialist/fertility clinic to discuss my options further?
Helpful Resources
Resources for financial fertility support:
- Fertile Future
- Consult your provincial healthcare
- Consult with your private insurance company
Melanoma Canada Support Services