Manisha Koirala, renowned for her captivating performances, faced a life-altering diagnosis in 2012. At stage IV ovarian cancer, Koirala's journey to recovery involved intensive treatment in New York, culminating in 2014. Her recent candid revelation about accepting infertility highlighted the profound impact of ovarian cancer on fertility. This poignant admission underscores the importance of understanding ovarian cancer’s effects on reproductive health and the possibilities for motherhood post-recovery.
The Impact of Ovarian Cancer on Fertility
Ovarian cancer originates in the ovaries, the small reproductive organs responsible for producing eggs. This type of cancer often spreads throughout the abdomen without manifesting noticeable symptoms. Koirala's reflection on her struggle with infertility due to ovarian cancer sheds light on a broader issue faced by many women. In an interview with NDTV, she expressed, “There are, somewhere, unfinished things in my life... Motherhood is one of them. It was tough getting ovarian cancer and not being able to be a mother. But I made peace with that.”
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Recognising Ovarian Cancer Symptoms
Dr Atul Narayankar, Consultant Medical Oncology, Wockhardt Hospital, Mira Road, explains that ovarian cancer starts in the ovaries and can spread to pelvic and abdominal organs, including the lungs. Early detection of ovarian cancer is challenging due to its subtle symptoms. Women experiencing persistent pelvic or abdominal pain, bloating, or a loss of appetite should consult a doctor promptly. Ovarian tumours can be benign or malignant, with the malignant ones being a serious health concern.
Understanding Fertility Loss
Fertility loss or infertility means an inability to conceive or maintain a pregnancy. Cancer treatments, particularly for ovarian cancer, can damage reproductive organs, nerves, or hormones essential for fertility. Factors influencing the risk of fertility loss include age, current fertility status, and type and duration of cancer treatments.
Discussing Fertility Before Treatment
Before beginning treatment, it is crucial for patients to discuss potential fertility loss with their healthcare team. Understanding the risks and exploring options for preserving fertility can help in making informed decisions. For those considering pregnancy post-treatment, various preservation methods are available.
Cancer Treatment and Its Effects on Fertility
Surgical Interventions
Surgical treatments like hysterectomy (removal of the uterus) or oophorectomy (removal of ovaries) result in immediate fertility loss. However, if ovarian cancer is detected early or involves a germ cell tumour, preserving one ovary and the uterus might be possible, allowing for potential future pregnancies. Tumor removal near reproductive organs can cause scarring, obstructing egg movement and affecting fertility.
Chemotherapy
Certain chemotherapy drugs, particularly alkylating agents, can lead to primary ovarian insufficiency (POI), where ovaries cease estrogen production and egg release, potentially causing permanent infertility. These drugs can also reduce the number of healthy eggs and induce early menopause.
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Radiation Therapy
Radiation targeting the pelvic area can destroy ovarian eggs and damage the uterus, leading to difficulties in carrying a pregnancy to term. Brain-targeted radiation may harm the pituitary gland, disrupting hormone release essential for fertility.
Hormone Therapy
Hormone-blocking drugs may induce temporary or permanent infertility. For instance, tamoxifen, used in some cancer treatments, can cause birth defects and should not be taken if planning to conceive.
Targeted Drugs and Immunotherapy
Certain targeted drugs and immunotherapy treatments can harm ovarian function or cause severe birth defects if conception occurs during treatment. High-dose chemotherapy and radiation used in bone marrow or stem cell transplants can also permanently damage ovaries.
Fertility Preservation Strategies
Egg and Embryo Freezing
Women can opt for egg or embryo freezing before starting cancer treatment. This involves hormone stimulation to produce eggs, which are then retrieved and either frozen or fertilised and stored as embryos. These can later be used for in vitro fertilisation (IVF) or with a surrogate.
Ovarian Tissue Freezing
For prepubescent girls, ovarian tissue freezing is an option. Part or all of an ovary is removed and preserved, to be replanted when the patient is ready to conceive.
Ovarian Shielding and Transposition
Ovarian shielding protects ovaries during radiation treatments, while ovarian transposition surgically repositions ovaries away from radiation exposure.
Hormonal Suppression
Gonadotropin-releasing hormone agonist (GnRHa) therapy suppresses estrogen and progesterone production, potentially safeguarding ovaries during cancer treatment.
Bottomline
Manisha Koirala’s journey through ovarian cancer and her acceptance of infertility highlights a crucial aspect of cancer recovery—understanding and managing fertility loss. While ovarian cancer poses significant challenges to reproductive health, advances in medical science offer various options for fertility preservation, providing hope for women aspiring to motherhood after cancer.