Cancer and Fertility
When you are initially diagnosed with cancer, a million thoughts are likely to race to mind (including thoughts like, “Will I die?”). Fertility preservation may not be top of mind, but is a crucial component of the treatment conversation for those of reproductive age.
According to Livestrong’s Fertility Program, more than 150,000 people a year are diagnosed with cancer during their reproductive years. A cancer diagnosis is a distressing, life-altering experience, and has the potential for future loss of fertility if not discussed upfront. For some cancer patients, infertility can be one of the most upsetting, long-term, permanent effects of treatment. While some oncologists are adept at talking about fertility preservation, some others may brush over the fertility risks associated with certain kinds of treatment due to their own discomfort with the topic, the presence of financial barriers, or the perception that fertility preservation might not be important to you. If this is the case, you, a partner, or a family member may need to initiate the conversation about the impact of your cancer treatment on fertility.
Surgery, chemotherapy or other targeted therapies, radiation, hormone therapy, and stem cell transplants can all cause damage to your fertility, by impacting reproductive organs, your endocrine system, and/ or your reproductive cells. Fertility preservation should be offered to all adolescent and young adult patients, regardless of partner status, age, or if you already have children. If your cancer is aggressive or already advanced, you may be in a position of having to make treatment decisions quickly, but sometimes it is possible to delay even a few days to allow for fertility preservation. Future fertility status is determined by a number of variables, including your type of cancer and treatment, the length and amount of treatment, your age when beginning treatment, how much time has elapsed since the conclusion of treatment and wanting to start a family, your general health, lifestyle factors, and your baseline fertility.
Here are a few ways to preserve your fertility (or to reduce damage to your reproductive system) before starting treatment, as a jumping off point for a conversation with your oncologist.
Options for fertility preservation for women:
Egg freezing (oocyte cryopreservation)-- medications are used to stimulate egg production and mature eggs are surgically retrieved, frozen, and stored for future use
Embryo freezing (embryo banking, embryo cryopreservation)-- medications are used to stimulate egg production and mature eggs are surgically retrieved, fertilized with sperm to become embryos, grown in the lab, frozen, and stored for future use
Ovarian shielding-- shields are placed over ovaries to protect from radiation
Ovarian transposition (oophoropexy)-- ovaries are temporarily relocated higher up in the abdomen to protect from radiation
Radical trachelectomy or radical cervicectomy-- surgery with the goal of removing cancer while preserving reproductive function
Ovarian tissue freezing-- experimental; an option for pre-pubescent girls who are not yet producing mature eggs; ovarian tissue is surgically removed and frozen for future use
Options for fertility preservation for men:
Sperm banking-- a semen sample (or a number of samples, when possible) is collected through ejaculation, frozen, and stored for future use
Testicular sperm extraction (TESE)-- testicular cells are surgically retrieved to determine if there are sperm present, frozen, and stored for future use
Testicular shielding-- shields are placed over testicles to protect from radiation
Testicular tissue freezing-- experimental; an option for pre-pubescent boys who are not yet producing sperm; testicular tissue is surgically removed and frozen for future use
These procedures can be prohibitively expensive, and your insurance provider may or may not cover the cost of fertility preservation. Be sure to inquire (or have someone else call on your behalf) about your benefits and how much they intend to cover. LIVESTRONG Fertility and the Sam Fund (see resources below) offer financial assistance for this purpose and may help cover what insurance does not. Inability to pay should not be a determining factor in whether someone pursues fertility preservation, but unfortunately this is a major barrier for many people. Some states are proposing or enacting legislation that requires insurance companies to provide fertility preservation coverage to young adult cancer survivors for this very reason.
If you decide not to pursue fertility preservation before beginning treatment, know that there are still options for family building after cancer treatment ends. Natural conception is possible when fertility is not greatly impacted by treatment or if fertility returns. You may still be able to carry your own pregnancy using a donor egg, sperm, or embryo or use a gestational carrier to carry the pregnancy. Adoption is another way to grow your family, with options for domestic or international adoptions. Again note that some of these options are very financially challenging.
In order to make an informed decision about fertility preservation before beginning treatment, consider asking your oncologist the following questions:
Could my cancer treatment cause infertility or increase my risk of infertility in the future?
When I am finished with treatment, is it likely that my fertility will return and how long might that take?
Am I at risk of going into early menopause?
Are there any other cancer treatments (considered “standard of care”) available to me that might not impact fertility?
Do I have time to delay the onset of treatment to pursue fertility preservation?
If I don’t pursue fertility preservation before treatment begins, what options are available to me once treatment ends?
Can fertility hormones cause my cancer to recur or a new cancer to develop?
Will I have any pregnancy complications due to my cancer or cancer treatment?
Is my cancer genetic? Can it be inherited by my children?
Can you refer me to a reproductive endocrinologist who I can learn more from? Does this person have experience with cancer survivors?
How much will fertility preservation cost me?
Is my treatment toxic to my partner? Do you recommend condoms or other birth control methods due to the treatment I’m on?
Resources
LIVESTRONG Fertility
-Financial support
-Search their portal to find a fertility clinic near you
https://www.livestrong.org/what-we-do/program/fertility
The SamFund
-Provides grants for young adults struggling financially because of cancer treatment
-Family building grants awarded
http://www.thesamfund.org/
The Oncofertility Consortium
-Information about fertility preservation options
-Connect with a patient navigator
https://oncofertility.msu.edu/
American Society of Reproductive Medicine (ASRM)
-Information about reproductive medicine (patient fact sheets, booklets, videos)
https://www.reproductivefacts.org/
