You’ve just been diagnosed with cancer – now what? In the U.S., more than 50,000 adults in their reproductive years are diagnosed with cancer each year.
Fortunately, cancer survival rates are increasing. With survival comes the opportunity to think about one’s future – a future that might ideally include children. The shock and trauma of a diagnosis leave little emotional or mental capacity to address the possibility of life after cancer, particularly the potential of having a family after cancer. However, this is the time when it is most critical to becoming informed, and move forward with treatment knowing your resources, options, and limitations.
Many patients don’t realize that some cancer therapies may compromise their ability to conceive naturally after their disease is cured. Some chemotherapeutic agent, for example, drastically increase future infertility risks by irreversibly destroying sperm in addition to the cells that manufacture sperm (in males), or damaging eggs (in females). Radiation to the reproductive organs (ovaries/testes) can have the same irreversible effect leading to infertility.
A cancer diagnosis is a life-changing shock. Nevertheless, the more information you can absorb in this critical time, the higher the likelihood that you’ll have control over your future fertility options.
Preparation After Diagnosis
Amid the stress of a cancer diagnosis, patients also often have a short window to weigh their future fertility given their treatment plan. While a cancer diagnosis is incredibly stressful and traumatic, your care team should be equipped to help navigate you to answers, options, or referrals to other physicians who can give you guidance and support to get through the early phases after a cancer diagnosis and preserve your options for parenthood.
What questions should you ask your care team? What choices might help you prepare for the future?
– Ask your oncology care team how much your treatment may impact future fertility. Remember, not all cancer treatments will affect future fertility.
– Seek out a reproductive endocrinologist – a doctor specializing in fertility care who may be better equipped to answer any questions you might have about future fertility and fertility preservation options. If your oncologist doesn’t know one in the area, ask your gynecologist or urologist for referrals.
Pre-treatment Oncofertility Options
For individuals who’ve already gone through puberty, freezing sperm, eggs or embryos (the result of combining eggs and sperm in a laboratory) are currently the best options.
For men, seek out a local, reputable sperm bank and make an appointment to freeze sperm. For women, there are several options to consider.
Egg and embryo freezing
Currently the best available options for women, this fertility preservation processes involve seeking out a reproductive endocrinologist who will coordinate care with your oncologist. Ideally, fertility preservation is a process that includes a 10-14 day course of hormone injections, followed by egg retrieval – a minor procedure. Once extracted, the mature eggs can be frozen in the laboratory (or fertilized with sperm, grown out into embryos which are then frozen) and can be stored indefinitely.
The American Society for Reproductive Medicine has a terrific educational video describing the process.
Ovarian tissue freezing
This experimental option, is offered at some academic institutions in the country: part of or a whole ovary is surgically removed and frozen in the hopes of re-implanting the tissue in the woman’s body post-cancer if needed. To date, very few children have resulted from this procedure to date, and research is still ongoing. Nevertheless, this option may be a viable consideration for female patients (pre- and post-pubertal) who do not have the time to go through a cycle of egg/embryo freezing and for women who are at extremely high risk of ovarian failure after cancer.
Shielding
If radiation is part of treatment, patients should talk with their oncologists about the possibility of shielding their ovaries or testicles while going through radiation if that treatment is anywhere close to the pelvic area.
Surgical options
Women diagnosed with cervical or uterine cancer may need radiation to the pelvis. For some women, outpatient surgery can be done to lift the ovaries out of their normal position in the pelvis, helping to protect against the damaging effects of pelvic radiation.
Medical therapy
Though somewhat controversial, certain medical therapies might be useful in protecting a woman’s eggs if used in conjunction with chemotherapy. This option requires a thoughtful conversation with your reproductive endocrinologist and oncologist.
Financial implications
I can’t afford to freeze eggs/embryos—are there still options?
The cost of freezing can be high: sperm freezing costs several hundred dollars per visit with storage fees usually running a few hundred dollars per year; egg or embryo freezing can cost $5000-12,000 or more with storage costs added to that burden. Some insurance plans now cover fertility preservation treatments for newly diagnosed cancer patients, particularly in California and Massachusetts. Also, funding and financial navigation may be available through the Livestrong Foundation, SaveMyFertity.org, RESOLVE, Fertility Within Reach, and the Oncofertility Consortium.
Post-Treatment Concerns
Cancer survivors can conceive healthy children
Many survivors worry that the chemo/radiation used to treat cancer might increase their chances of having a child with a birth defect. Studies have shown no increased risk of birth defects in children conceived by cancer survivors.
Pregnancy doesn’t make cancer come back
Many breast cancer survivors, in particular, fear that pregnancy hormones might activate a cancer recurrence. Cancer survivors who wait to conceive for at least 1-2 years post cancer treatment do not appear to have a higher recurrence risk compared to survivors who opt not to conceive. Nevertheless, each case is different and warrants a thoughtful conversation with your oncologist before starting to try and have a baby.
Cancer-induced menopause: can I have kids?
Donor eggs can give women the opportunity to have a child: the donor eggs are fertilized with sperm in a lab setting (similar to the IVF procedure outlined above), and the resultant embryo can then be transferred into the woman’s uterus.
Alternative Options
For women who are post-hysterectomy or who have been told not to get pregnant for medical reasons, gestational carriers may be able to carry the resultant pregnancy. Adoption is another option for some to have a family.
Donor sperm may be an option for males who no longer produce sperm after their cancer treatments.
Keep in mind, none of these options are a guarantee of a future pregnancy but certainly offer higher likelihood than not pursuing fertility preservation at all. Most importantly, many cancer survivors can and do go on to conceive naturally.
Parenthood does not have to be the sacrifice one must make for survival.