Cancer is different for the young, especially if you hope to conceive. There's no doubt that cancer treatment impacts fertility, and young women in particular shoulder heavy burdens. For some, the thought of a dream unfulfilled is as devastating as the diagnosis itself. Across the internet, women wonder about the effects of cancer and its treatment on their fertility. Is chemotherapy or radiation worse for trying to conceive? Will the treatment that saves my life make me infertile? Every woman battling cancer deserves to know the answers to such crucial questions.
"Radiation therapy is thought to be more damaging to ovarian tissue than chemotherapy," explains Nilesh Vora, MD, an oncologist-hematologist at Long Beach Memorial Medical Center. "Specifically, pelvic radiation carries the highest risk of permanent ovarian failure."
But chemotherapy can also be toxic, especially when drugs contain alkylating agents, long-known to increase your risk of infertility. But every cancer and treatment is different. Romper spoke with Ralph Kazer, MD, of Northwestern's Oncofertility Consortium, where he's been working alongside oncologists to preserve the reproductive futures of cancer patients for close to 20 years.
"We were one of the first centers in the country to get the ball rolling," he explains. "Until about 2000, most cancer patients weren't really counseled about fertility issues because their cancer doctors were so focused on getting them cured." Over time, however, it became increasingly clear that a great many patients would become long-term survivors. "People started getting with the notion that fertility is an important life issue, and that it needs tending to."
The vast majority of Kazer's patients choose egg banking or embryo banking, freezing cells in liquid nitrogen, sheltering a small part of themselves from the potentially poisonous effects of cancer therapy. Patients may later rely on those eggs or embryos to become pregnant through in-vitro fertilization. "That's what makes the whole thing worth it," says Dr. Kazer. "It's extremely gratifying to see those babies that wouldn't have been born otherwise. And it goes without saying that patients are enormously grateful."
Not every patient who freezes her eggs will come back for them. Some will get pregnant on their own, and some don't survive. According to Kazer, however, every patient that goes through with fertility preservation gets something out of the process: namely, hope.
Kristin Smith works at the Oncofertility Consortium as a patient navigator, arming patients with critical knowledge and serving as a point of contact, a bridge between the worlds of cancer and fertility. She echoes Kazer's emphasis on the hopefulness of their work:
"I think when you're taking, taking, taking, from patients, they want something in return. For many patients, being able to proceed with fertility preservation is one of the few things they can control in their cancer care, and that's huge, to be able to have something you can actively choose to do. Because no one's coming to us saying, please give me chemotherapy."
Oncologists follow standard procedures, so unfortunately you can't choose chemotherapy over radiation, or modify the dose of a fertility-harming drug, even if having a genetic link to your child is extremely important to you. However, your oncologist can refer you to a reproductive specialist, and delaying a week or two to freeze your eggs only very rarely worsens your prognosis. The problem is that many patients must advocate for themselves. Egg banking simply isn't part of the process at most treatment centers, and perhaps as a result, few women with cancer freeze their eggs. Another barrier is cost. While insurance might not yet cover the fertility preservation in most states, many fertility centers offer discounts and assistance for cancer patients.
Before your course of treatment begins, "you should be given every opportunity available to learn about your options for dealing [with fertility issues]," says Kazer. "It should not be swept under the rug." If you've been diagnosed with cancer, and you know you want to have children, check out Stupid Cancer, Fertile Action, and Livestrong for resources in your area.