I had an adult survivor of a childhood cancer tell me recently that she was very thankful to be alive but felt she paid a very high price for that survival, as she had recently discovered that she was infertile as a result of her treatment. She was hopeful that somehow her experience could be translated into improved options for future childhood cancer survivors. She wondered: had she known or had access to fertility preservation methods before she began cancer treatment, would she (and her parents) have made a different treatment decision? Would her fertility options be different now?
When you or your child has cancer, life-saving treatment is, of course, your first priority. While there have been major improvements in both childhood cancer and adult onset cancer survival, many of these treatments can put survivors at risk for infertility. Fertility—the ability to conceive a child or maintain a pregnancy—can become impaired from some cancers or cancer treatments. Although infertility can be one of the most distressing of the long term effects, the good news is that there is increasing success with improved fertility preservation techniques, and treatments are becoming less toxic.
A cancer diagnosis is overwhelming enough on its own. The focus is on finding the best doctors and most successful treatment. Unfortunately, sometimes survivors are not aware that infertility may be a consequence of their treatment. Beginning the conversation can be difficult for both the provider and patient, but it is necessary.
Which Treatments are most likely to cause Infertility, and who is at most Risk for Infertility?
Not all cancers and cancer treatments cause infertility and it is important to understand your individual risks. Chemotherapy can damage eggs and sperm, as well as the cells in the ovaries and testicles that produce sex hormones. Radiation can reduce the chances of fertility when treatment is directed at the ovaries or testicles, the nearby pelvis or abdomen, or the whole body. Future infertility also can result from radiation to the brain. In girls and women, high-doses of radiation to the pelvis may damage reproductive organs, making it harder to get pregnant and to carry a baby.
The effect that cancer treatment may have on fertility depends on many factors, including the person’s age at the time of cancer therapy, the specific type and location of the cancer, and the type and dose of treatment that was given. In girls, infertility may be less of a risk when treatment is before puberty. Similarly, the closer to menopause a woman may be, the greater risk she will have to be pushed into menopause and become infertile. Women with breast cancer may be advised to not attempt pregnancy after treatment because it may increase their risk of the cancer returning.
How do you best Advocate for yourself or your Child?
Become informed. Ask your oncologist about the risk of infertility with the proposed treatment options. Ask about fertility-saving options. Read and research and don’t be afraid to ask questions. Ask for a referral to fertility specialist to discuss your options.
Many times, it is very difficult to think about future fertility at a time when you and your family are overwhelmed with fear and sifting through lots of information. The primary concern is always about choosing the best treatment to preserve your life or the life of a loved one – this is understandably so.
Patients and survivors often are unsure about what types of questions to ask about their fertility options. Physicians and healthcare providers can do their part by becoming well informed about resources and fertility specialists in their community. Sometimes the hardest part is just broaching the topic. Follow this link for tips on starting the conversation:
Resources for Healthcare Providers and Patients
Save My Fertility
SaveMyFertility.org is an authoritative resource for adult cancer patients and the parents of children with cancer who want to learn more about:
- Preserving their fertility before and during cancer treatment, and
- Protecting their hormonal health after treatment.
SaveMyFertility.org also provides information and guidance to oncologists, endocrinologists, and other health care providers concerned with the reproductive health of cancer patients and survivors. They have developed mobile phone applications, pocket guides and patient information.
Fertile Hope is a LIVESTRONG initiative dedicated to providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility.
American Society of Reproductive Medicine
ASRM is a very good resource about all aspects of the reproductive lifecycle. The website also has a list of states that mandate some form of insurance coverage for infertility treatments.