What it means to survive cancer today is very different from 20 or even 10 years ago.
Back then, doctors and patients approached cancer like a monster to be slain; surviving was the only goal.
But as cancer treatments have improved, young cancer patients have begun demanding more than just survival. They want to lead normal lives.
They want to have babies.
They want to have babies.
Yet, depending on the treatment, curing cancer can reduce patients' chances of having children or erase them entirely. Infertility is a possibility faced by at least 10% of the 1.4 million Americans under age 40 who find out each year that they have cancer.
Many are not informed about ways to safeguard their fertility.
The challenges of fertility education
Some
patients worry that efforts to protect their fertility will delay
cancer treatment. Others don't know exactly what their options are.
Most
hospitals that treat cancer neither offer fertility counseling nor have
reproductive oncologists who can help. And, in most cancer centers,
it's not clear who's responsible for handling fertility questions- the
oncologists? The surgeons?
"It falls through the cracks," says Terri Woodard, M.D.,
assistant professor in the Department of Gynecologic Oncology and
Reproductive Medicine at MD Anderson. "If patients say they don't care
about that right now, they just want to get rid of the cancer, they need
to be told that in five years they may feel differently. They should at
least be informed."
Some types of cancer treatments, such as chemotherapy, radiation and surgery, may cause temporary or permanent infertility.
These side effects
are related to a number of factors, including the patient's age at time
of treatment, the specific type and dose of radiation therapy and/or
chemotherapy, and length of time since treatment.
When
cancer or its treatment can potentially cause infertility or sexual
dysfunction, every effort should be made to inform and educate the
patient about this possibility.
When the patient is a child,
this can be difficult. The child may be too young to understand issues
involving infertility and reproduction, or parents may choose to shield
the child from these issues.
Fertility options for cancer patients
Patients
who are concerned about the effects of cancer treatment on their
ability to have children should discuss this with their doctor before
treatment. The doctor can recommend a counselor or fertility specialist
who can discuss options and help patients and their partners through the
decision-making process.
Options may include freezing sperm, eggs, embryos or ovarian/testicular tissue before treatment.
For men, the solution is usually as simple as freezing sperm, but fertility preservation in women is far more complex.
Depending
on how quickly doctors need to forge ahead with cancer treatment, a
woman can choose to harvest and freeze either eggs or embryos (assuming
she has access to sperm). The procedure takes approximately two weeks.
But
that time can be reduced to one hour with ovarian tissue
cryopreservation. With this cutting-edge technique, an ovary or a piece
of one is laparoscopically removed and frozen before cancer therapy,
then transplanted once a woman decides she wants to get pregnant.
Doctors
have been studying this procedure for at least a decade, but it has
only recently begun yielding results. To date, more than a dozen live
births have been reported from transplanted frozen ovarian tissue.
Other
alternatives include ovarian tissue freezing and ovarian transposition.
Women may undergo surgery to protect the ovaries by moving them out of
the field of radiation.
What you can do to protect your fertility
While
not all patients are at risk, be sure to speak with your doctor about
whether you should be concerned about infertility before starting cancer
treatment. Use these questions to guide your conversation:
- Will my cancer treatment affect my fertility, either temporarily or permanently?
- What are my options to preserve my fertility before, during or after my cancer treatment
- What is the best option for me, given my cancer type and treatment?
- When might it be safe for me to start a family after my cancer treatment?
