Cancer begins with a single cell, but quickly expands to affect every facet of life, even after remission. Emotional trauma, missed school days, and loss of fertility are only a few of the ways that cancer lingers long after the fact, leading survivors to ask, "Can I get pregnant if I had cancer as a child? Or does the treatment that saved my life prevent me from having children of my own?"
"We talk about how child cancer survival rates are over 80 percent — four decades ago most of these children would not survive, but now we know they will," notes Dr. Asma Javed, M.B.B.S, of The Mayo Clinic Fertility Preservation Program, part of The Mayo Clinic Children's Center, in an interview with Romper. And this statistic, while deeply encouraging, puts fertility front and center. Javed explains:
"As young adults, they will question why they don't have children and why there weren't any options offered to them. There are studies that show that for long-term cancer survivors, their number one regret . . . is not being able to have children."
While chemotherapy and radiation treatments absolutely deal devastating blows to the reproductive system, new evidence suggests the fertility of childhood cancer survivors might be more resilient than previously thought, according to The New York Times. In fact, a large study in The Lancet Oncology recently showed 64 percent of ex-cancer patients who sought fertility treatment as adults became pregnant. It's a promising statistic, and the study notes that female survivors who haven't undergone radiation to the pelvis or brain have especially good odds. Nevertheless, the study recommended all children diagnosed with cancer consider fertility preservation options when possible.
Javed works with children at a high risk of infertility. For teenagers, egg freezing and sperm banking are the best recourse. Many patients follow this tried-and-true path to build their families after cancer.
But Javed's study focuses on prepubescent patients — those too young to bank sperm or freeze eggs. Even 10 years ago, these kids had no options. Today, tissue banking — while still experimental — has the potential to brighten countless futures. For girls, Javed stores a piece of the ovary. For boys, a slice of testicular tissue. The procedures are quick and low risk. Javed's team hopes that doctors will re-implant these tissues to give survivors a chance at conception down the line. According to Javed:
"Worldwide now, there are over 120 live births from girls or women who had ovarian tissue stored prior to receiving cancer therapy . . . that has shown success. So much so that we believe in the next decade or so, ovarian tissue storage won't remain experimental. It will be standard of care."
While there hasn't been a live birth resulting from testicular tissue storage, the science is promising. And storing reproductive tissue has other benefits for the young cancer patient.
"Take for example a 5-year-old boy or girl. Say their cancer therapy did obliterate their ovarian or testicular function. Well, now they're not going to go through puberty, either." Re-implanting tissue back into the child when she's 13 helps her body make its own estrogen, and prevents a lifetime on hormone replacement.
Too many parents and children with cancer remain unaware of their options. Javed hopes this will change, and soon. In the meantime, she encourages families to speak to their oncologists about fertility preservation. Tissue freezing, along with sperm and egg banking for adolescents, may lead to fewer regrets for the men and women these children grow up to be.
"I've been surprised by how much this offers hope," says Javed.
Survivors of childhood cancers can and do conceive. New data is encouraging, especially for women, so visit a fertility specialist to have your chances assessed. Livestrong, SaveMyFertility, and Stupid Cancer all offer excellent resources for patients and survivors looking to the future.