CCoPE
Date: 2003-11-22

Question:
Hello, This is my first visit to your forum. I have a couple of very specific questions related to a bout with colon cancer I had last year and the effect(s) it may have had on my fertility. I was diagnosed at the age of 36 with T3N0M0 adenocarcinoma of the ascending colon. A right hemicolectomy was performed, and seventeen nodes were removed, all negative. My surgeon said my prognosis was so good that he would not recommend adjuvant chemotherapy because of its minimal benefit. Three oncological opinions later, I decided to go ahead with a modified Roswell Park regimen (two weeks on, two off) of 5FU and Leucovorin over a period of eight months (infusions took five to ten minutes apiece.) Side effects were minimal, and I maintained normal menstrual cycles throughout. My doctor at Sloan-Kettering advised me that my fertility would likely be unaffected, but recommended waiting until a year after chemotherapy cessation to attempt conception--not because of residual drug effects, but because most recurrences take place during this time. I have six months to go until the magical milestone, and notice that my cycles are getting longer every month. I know I always ovulate because of meticulous mucus/cervical/temperature checks, but some cycles are as long as forty days. My questions: 1) Could 5FU alone have significantly affected my ovaries and/or egg quality, thereby rendering me in- or subfertile? I was told that since 5FU was an antimetabolite with no DNA-damaging properties, it would not adversely affect my reproductive system. 2) Is it true that a woman who undergoes ANY course of chemotherapy as she gets closer to menopause--particularly mid-thirties and up--can expect to undergo full menopause ten or so years earlier than luckier women? 3) Should I start trying to conceive before the full year is up to maximize conception chances, especially if my cycles seem to be getting more erratic each month? Any advice would be greatly appreciated. I am very anxious to get pregnant.

Answer:
The following information should not replace the assessment and advice you have been receiving from your physician (cancer specialist, obstetrician, or any other healthcare provider). It is offered for your information only

Yes, it is possible that 5FU affects the ovaries. The effect varies among women. There is no sufficient data to suggest that any chemotherapy causes menopause to be early by ten years. It varies a lot. Starting to conceive now is reasonable if your cycle really begins to be erratic. But this should not be defined by you, based on your own assessment, but rather in consultation with a fertility expert.