Fertility and Cancer: Understanding Your Options

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.

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?

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Parlez-vous Fashion?

Some languages you have to learn by sticking your head in a textbook for hours. Others you can learn by sticking your head in a Vogue for a couple hours. I think the latter sounds a lot more fun... The language I'm talking about is of course the language of fashion. True fashionista status comes with not only proper appreciation but pronunciation of the oh-so-fabulous designers and houses which produce the clothing and jewelry we adore. Here are some commonly mispronounced names and the proper ways to say them so you can boost your fashionista status.

CBG Max Azria
The BCBG Max Azria brand was created 20 years ago by Tunisian-born designer Max Azria. The line is known for their contemporary women’s sportswear and eveningwear. According to writer Patricia Gajo, Azria says that “BCBG is a Gallic acronym for bon chic, bon genre, which means ‘good style, good attitude’, a common term in France that Parisians use synonymously with preppy or Euro riche.” To properly pronounce the word, just say the letters as they are: B C B G. Then Max (nothing special, just the name). Then the part that most people mispronounce: Azria. “Az” like the word “as”, and “ria” like the name “Mia”. Ree-uh. I cry a little on the inside when I see people write or say “BCBG Max Azaria”, as if he were somehow related to actor Hank Azaria. No, dears, he is not. So BCBG Max Azria it is.

BVLGARI
BVLGARI is an Italian fine jewelry house first opened in 1884 in Rome. Today, though, it also has leather goods, watches, perfumes, silks (ties and scarves) and more to its name. The name BVLGARI is written in Latin, so the letter that looks like a “V” is actually a “U”. So it’s pronounced Bulgari—BULL(like the animal)-GAHR(as in ‘garden’)-EE(like the letter “e”). In fact, if you type “bvlgari” into Google, it will lead you to the BVLGARI website, which is actually www.bulgari.com.

Chanel
s is a VERY important one! Some people might think it’s a no-brainer, but if I hear another person pronounce it “Channel” I will actually lose my mind. The House of Chanel was started in early 20th century France by the one and only Mademoiselle Gabrielle Bonheur “Coco” Chanel. Chanel has fine women’s sportswear and eveningwear and is run today by Karl Lagerfeld (pronounced “Carl Loggerfelld”). Chanel is properly pronounced “Sha-nelle”, “Sha” like in “shove” and “nelle” like in the name “Nell”. Chanel.

Givenchy
It’s true, these French names can be difficult, but this is another important one. Hubert de Givenchy opened the House of Givenchy in 1952, alongside greats like Christian Dior and Balenciaga. He was also the chief designer for Jacqueline Kennedy Onassis and Audrey Hepburn. Though Givenchy himself retired in 1995, the Givenchy Femme line is perpetuated by Italian designer Riccardo Tisci. Givenchy is pronounced with a French “J” sound, a soft “jz” made with the tip of the tongue, almost like saying “shh”. So it’s “jzhiv-on-shee”, since the French “e” makes a long “o” sound, and the “ch” is a “sh” sound. Givenchy.

Hermès
Known for its little orange logo, Hermès is a French company begun in 1837 by Emile Hermès. It produces fine leather goods, like handbags and wallets, and fine silk goods, like scarves and ties, among other things like perfume, shoes, jewelry and more. Hermès is pronounced “AIR-MEZZ”, not “HER-MEEZ”. So when you see the little orange logo, you know what to say. Hermès.

Tommy Hilfiger
Making his first collection in 1985, Tommy Hilfiger has since grown to include not only menswear and women’s wear, but children’s clothes, bedding, and more. The Hilfiger style is said to be classic Americana, and has many lines of denim and casual wear to back that up. You’d think that since this is an American designer, people might not butcher the pronunciation, but every so often I hear people say “Hillfigure” and it’s just not right. The correct pronunciation of this designer’s last name is “HILL- (like “hills and valleys”)- FIG- (like the fruit) ER (like in the word “nerd”). Hilfiger.

Yves Saint Laurent
Though he first worked for Christian Dior, Yves Saint Laurent introduced his own line in 1962. He invented several items of clothing, like the smoking jacket, the sheer blouse, and the jumpsuit. Though Saint Laurent retired in 2002, the label continues under the creative direction of Stefano Pilati. Saint Laurent believed that “dressing is a way of life” and is one of the most important, influential designers of the 20th century. His first name is pronounced “Eves” like “Christmas and New Year’s Eves”. “Saint Laurent” is his last name, pronounced “SAHN” like in “song” and “LORE-ONT” like “lore” in the word “folklore” and “ONT” like in the word “want.” Yves Saint Laurent.