No matter what age you are, receiving a cancer diagnosis is scary. But if you’re a younger woman who hasn’t started a family yet, it can be even more terrifying. Does this mean you can’t have the children you always wanted?
Fertility Can Be Preserved
Many young cancer patients have options to preserve their fertility. Advances in technology have made egg retrieval and freezing for women much easier than it used to be.
In Maryland, a state law mandates insurance plans cover iatrogenic infertility, which is fertility preservation for cancer patients of child-bearing age and in vitro fertilization (IVF) treatments later. (Patients will, however, need to pay annual cryogenic—freezing—storage fees in most cases.)
Will Cancer Treatment Affect My Ability to Have Children?
Fertility is most often affected by chemotherapy, radiation and surgeries that involve the removal of parts of the reproductive system.
“Fertility issues depend upon what kind of cancer patients have and the risk of their medications, along with the dose and how long they have to take the medication,” said Selvi Lingam, MD, an oncologist at the University of Maryland St. Joseph Medical Center’s Cancer Institute. “A person’s age also plays a major part in fertility.”
In short, receiving multiple medications for treatment makes predicting fertility hard, also the older you are, the more likely treatment will cause the loss of your fertility. Chemotherapy with anticancer drugs—known as alkylating agents—especially carries a higher risk for infertility.
How Can I Plan for Future Fertility If I Have Cancer?
Fertility preservation for male cancer patients is generally an easier process, unless the man is unable to ejaculate due to cancer growth. Sperm is collected and cryogenically preserved before radiation or chemotherapy begins.
The two most common fertility preservation options for women are egg freezing and embryo freezing.
- Egg freezing: A woman’s eggs are surgically removed during ovulation.
- Embryo freezing: The removed eggs are fertilized with a partner’s sperm and the viable embryos are frozen for later implantation in the patient or a surrogate.
More experimental fertility treatments like ovarian preservation through ovary tissue freezing may also be an option for some patients.
When Should I Ask My Doctor About My Options?
Patients don’t need to wait for an official cancer diagnosis to talk to their doctor about whether your fertility could be affected.
“Patients should start this process as soon as possible,” Dr. Lingam said. “They should have the conversation early and request a referral to a reproductive endocrinologist. For women, the process takes four to six weeks, because they need to be at a particular time in their menstrual cycle for the procedure. Plus, they need to take medications for almost a week to stimulate their ovaries so that they can get enough eggs to store, so it is time-consuming.”
Dr. Lingam said that it’s always easier for a patient to change her mind and cancel an egg retrieval procedure than to start one later, when cancer treatment may become more pressing.
“Have a consultation with a doctor to talk about your options,” Dr. Lingam said. “It may take time to decide what you want to do.”
When Can I Try to Get Pregnant?
Dr. Lingam recommends women wait two years after the end of cancer treatment before trying to conceive. This is especially the case for breast cancer patients, because pregnancy increases hormones that can promote cancer growth.
“That waiting period gives patients enough time to get beyond the window of early recurrence,” Dr. Lingam said.
Breast cancer patients will also have to plan stopping Tamoxifen or other hormonal therapies for at least two months before starting fertility treatments, because it can cause birth defects.
Will I Be Able to Get Pregnant?
Many younger cancer patients are able to conceive healthy children later in life with zero fertility treatments needed. Other patients decide never to have children for reasons unrelated to their health and will donate or destroy their frozen eggs or sperm. And IVF will not always be successful.
If preserving your future fertility options is important to you, the University of Maryland Cancer Network, a group of cancer centers across Maryland that connect you with national experts and the latest treatments close to home, are here to help you make the decision that’s right for you.
“Patients should involve their families and try to make decisions on what they need and try to start this process early on,” Dr. Lingam said.
