Fertility and cancer treatment
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology Social Work
MAY 22, 2019
For younger people diagnosed with cancer, a very big issue is often fertility. This is defined as the physical ability to have a child. For men, it means contributing sperm to fertilize an egg. For women, it means becoming pregnant and carrying a baby to term. For people who have not yet had children or who have not completed their families, the possibility of losing this choice is terrible.
After diagnosis, there is usually time to consider options to preserve fertility before beginning treatment. Surgery can sometimes preclude fertility (for example, a woman's losing her ovaries or uterus) and chemotherapy treatments may damage or destroy eggs or sperm. Some chemotherapy drugs carry a bigger possibility of this damage than others; ask your doctor. Also ask about the potential risks of targeted therapies or immunotherapies. These are definitely questions that you want to ask and have answered before beginning therapy.
There are occasions when someone does not have the opportunity to pause and consider ways to preserve fertility. For example, a new diagnosis of acute leukemia requires immediate treatment, and there could be situations that demand urgent surgery. Most of us believe that saving our own lives is of paramount importance, and, if you experience this difficult situation, there will be time to grieve the losses later. First, take care of yourself.
There is a parallel question about the safety of later having children. For men, it is probably straightforward in terms of risks. For women, there may be worries about the hormones of pregnancy or the changes caused by surgery to parts of the body involved in pregnancy. For everyone, there is the very serious worry about prognosis and parenting. This is beyond the scope of this blog, but all of us must think about what might happen to a child who loses a parent and be absolutely certain that there are people who would love and care for her. Of course, this should be part of anyone's thinking about pregnancy, but people who have had cancer are more aware of this chance.
Assuming that there is time to preserve fertility, what happens? It is easier for men who can visit a sperm bank to donate and preserve sperm. Women can meet with a fertility expert, usually at an IVF center, to consider the possibilities. Generally this means treatment with hormones to stimulate egg production and then egg harvesting. Again, these eggs can be frozen and safely stored for a long time. Sometimes couples prefer to fertilize the eggs and freeze embryos. It is unlikely, although possible, that insurance will cover these costs. There are some funds that can help; the Alliance of Fertility Preservation has an excellent website and list of possible resources .
Well-meaning people often tell younger adults who are unable to preserve their fertility that there are other ways to have a family. Of course that is true, but it is little comfort when mourning the loss of a dream. The safe passage of time will help you heal, and the full bounty of a long life can bring many joys.
Was fertility preservation part of your cancer experience? Share your story