Having children after cancer treatment

Author: Mia James

Before Tom Whiteside was diagnosed with stage IV Hodgkin’s lymphoma at age 26, starting a family was not in his immediate plans. “At the time I was diagnosed, I had no immediate plans to start a family, though like any young adult I assumed that one day I would,” he says. And even though fatherhood seemed a long way off at the time, the lymphoma diagnosis made having a family an immediate consideration. “Being told your fertility will be compromised by treatment forces you to think long and hard about something you hadn’t otherwise considered,” Tom explains.

For men and women who have been diagnosed with cancer and want to have a family, preserving fertility is a major concern as they enter treatment. The ability to conceive a child after treatment, however, may still not be among their foremost thoughts. “Fertility may not be the first thing that comes to mind when you hear the words ‘You have cancer,’” says LiveSTRONG Navigation Project Specialist Emily Eargle. LiveSTRONG, an organization that serves people affected by cancer and empowers communities to take action against the world’s leading cause of death, operates Fertile Hope, an initiative that provides reproductive information, support, and hope to cancer patients and survivors who are at risk of infertility.

Eargle explains that even though fertility may not always be in the forefront of discussions about cancer and treatment, there are established procedures and resources to help patients and survivors address potential infertility. She says that it is first important to understand your risk of infertility, beginning with the question What is the cancer diagnosis and what are my treatments going to do to my fertility? Factors including the type of cancer you are diagnosed with and the type of treatment you’ll receive will affect your chances of conceiving naturally. Notably, cancers affecting reproductive organs, radiation that’s close to reproductive systems, and chemotherapy can pose a risk to fertility, as can other diseases and treatments.

In Tom’s case, he knew that the treatment regimen had a 90 percent infertility rate. Even though he was single at the time and hadn’t thought much about having a family, Tom recognized that fertility preservation was “the only shot I’d have.”

How fertility preservation works

Approaches to preserve fertility exist for both men and women. Choices are determined according to patient age, type of diagnosis and treatment, and personal preference. The various types of fertility preservation available today provide options for survivors facing fertility challenges. “There’s at least some choice, some option, for just about everybody, so they don’t have to go into treatment expecting to come out of it with no alternatives,” says Edward L. Marut, MD, medical director of the Fertility Centers of Illinois Highland Park IVF Center.

The standard approach for fertility preservation in men, says Dr. Marut, is sperm banking. “If a man is to undergo any kind of chemotherapy or radiation therapy, the simplest thing is for him to bank semen.” This can be done at a clinic or at home, with products such as the Live:On kit (liveonkit.com), a semen collection and preservation kit. Whether sperm is collected at a clinic or at home, it is sent to a lab to be preserved or frozen and is then stored at a sperm bank. Dr. Marut explains that banked sperm can be available for use when the survivor wants to start a family; it can be used for in vitro fertilization (IVF ), where the egg is fertilized by the sperm outside the body, or for artificial insemination, where the sperm is placed in the female reproductive tract.

Tom banked sperm prior to treatment for lymphoma. He says that he banked four times and had even delayed beginning treatment by one day so that he could bank a final time. “[Sperm banking] did give me the option of having children later should I choose to start a family,” he says.

For women, Eargle says that the standard approach is embryo freezing. A woman begins this process by taking medication to stimulate the ovaries to release eggs and then undergoes a minimally invasive surgery to extract the eggs. The eggs are fertilized in the lab (using the partner’s sperm or donor sperm if the woman does not have a partner), and embryos are made. “Once the embryos have been created,” says Eargle, “they are then frozen and stored.”

Another option of fertility preservation for women is egg freezing. The process, which is similar to embryo freezing except that the eggs are frozen before they’re fertilized, is still considered an experimental procedure by the American Society for Reproductive Medicine. Though egg freezing is newer than embryo freezing and researchers are still gathering data, the process is being used and can be successful. “This is a really good option both for women who are not in a committed relationship and those who are but who would prefer to preserve just eggs,” says Eargle.

Success rates for fertility preservation

Eargle and Dr. Marut agree that, overall, the success rates for fertility preservation are good and that options now exist to suit many needs. “It’s to the point where if someone wants to build a family— even having had a cancer diagnosis and treatment and even with the loss or presumed loss of fertility function— there’s something out there that’s available for them to be able to have the family that they’ve wanted,” says Dr. Marut. D r. Marut explains that the success of fertility preservation depends on individual characteristics, such as the survivor’s age, as a woman’s ovarian reserve (number of eggs) decreases as she gets older. “The better the ovarian reserve, the less damage that’s going to be done by any kind of treatment,” he says.

Choosing a fertility preservation method

Survivors and doctors work together to determine which fertility preservation approach is best for each individual. Eargle says that it’s important that survivors are educated about all their options for having a family—including alternatives like adoption and surrogacy— if fertility isn’t preserved before treatment. Thorough education is important, she explains, especially when survivors have only a brief period between diagnosis and beginning treatment. It’s a short time frame, says Eargle, in which “a pretty big life-changing decision has to be made.”

Considerations in the fertility preservation planning process include the survivor’s age (for women, conception rates decrease with age), diagnosis and treatment (whether reproductive systems are directly affected and how quickly cancer treatment needs to begin), and relationship status (whether the survivor is in a committed relationship). Each factor plays a role in determining the best solution for each patient. Relationship status, for instance, may influence decision- making for a woman who does not currently have a partner; she may choose to preserve eggs rather than embryos in hopes that she will have a partner when she’s ready to conceive, or she may choose to use donor sperm and preserve embryos.

Paying for Fertility Preservation Finances are a big consideration for survivors looking for ways to preserve their fertility. “This is not necessarily a cheap thing,” says Eargle. The average cost of embryo freezing begins at $9,000, and egg freezing costs $7,000 or more. These expenses, says Eargle, are only the upfront costs, and costs will rise due to long-term storage expenses.

Fortunately, there are resources available to help survivors with the expenses of fertility preservation, such as Fertile Hope’s Sharing Hope Financial Assistance Program. “Cost is a really big barrier for those who are interested in preserving fertility,” says Eargle. “The purpose of the Sharing Hope program is to ease the burden of the cost and increase access to services.” The program partners with fertility centers across the country and negotiates discounted rates for cancer patients who are in the Fertile Hope program and who meet financial eligibility criteria. The program also donates precycle medications to eligible patients through a relationship with EMD Serono Inc., a division of Merck KGaA, a global pharmaceutical and chemical group.

Emotional support

Fertility can be an intensely personal and emotional issue, particularly in the face of a cancer diagnosis. To help patients cope emotionally with the process, both Fertile Hope and many fertility centers, including the Fertility Center of Illinois, offer counseling services. Through LiveSTRONG Cancer Navigation Services, survivors can choose between brief, long-term, over-the-phone, in-person, or e-mail emotional support. Both a licensed professional counselor and a licensed professional social worker are on staff to take care of emotional support needs.

Emotional support can be especially important when a couple or an individual is not able to conceive following fertility preservation. In such cases, Eargle says, LiveSTRONG offers access to the same emotional support services described earlier. Sometimes, she says, this support includes grief counseling. “It can be a big loss for someone to realize that maybe they can’t conceive naturally,” she explains. In that case, navigators at LiveSTRONG are also trained to discuss options such as adoption and surrogacy (with or without donor eggs or sperm), if those options are appealing to the patient.

Fertility and life after cancer

Having a family may be the main goal of fertility preservation, but, according to Eargle, a survivor’s decision to be proactive about his or her future in this way can also affirm the will to survive. “We hear a lot of times that preserving fertility is a beacon of hope and light for the future; it’s really something that is a way to step back and say, ‘I can get through treatment and there can be life after cancer,’” she says. “It can have such a transformative impact on somebody’s life.”

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