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Know Your Fertility Options

Before, During, and After Cancer Treatment

by Teresa K. Woodruff, PhD, and Kate Waimey Timmerman, PhD

In April 2010, Tiffany and Dave were juggling their busy lives and in the midst of planning a European vacation when Tiffany noticed an unusual lump in her breast. As a typical, healthy 28-year-old, Tiffany assumed the lump was benign, and when she went to the doctor to have it checked, she was shocked to find out it was breast cancer.

Immediately after her diagnosis, Tif­fany was sent to a variety of specialists, including the fertility preservation pa­tient navigator at Northwestern Memorial Hospital in Chicago, IL. The navigator discussed the potential effects that cancer treatment could have on her reproduc­tive health. Since the couple planned to have children, the navigator set Tiffany up with a preservation specialist. Dave reveals, “I didn’t know much about chemotherapy, and I didn’t even think about how it would affect her fertility because she’s so young.”

After the couple dis­cussed their options, they decided to un­dergo embryo banking. “We started that process, and we were able to bank six embryos,” Tiffany says.

Oncofertility Options
Tiffany is one of the increasing numbers of young cancer survivors who are discussing fertility with their doctors prior to, dur­ing, and after cancer treatment. Over the past 10 years, the number of options for men, women, and children to preserve their fertility in the midst of potentially damaging chemotherapy, radiation, and surgery, has significantly increased. These options have launched a new area of focus in cancer care – oncofertility, which examines the decision-making, communication, and financial consider­ations of survivors wishing to have children after cancer.

Adult women can choose among a variety of fertility preservation options, including freezing eggs, embryos, or ovarian tissue prior to treatment. Men may bank sperm or undergo testicular sperm extraction. In addition, experi­mental procedures that may provide reproductive opportunities for children by the time they are ready to have their own children are available.

Currently, prepubescent girls who have cancers of the pelvis or the blood may not be able to take advan­tage of fertility preservation treatment. How­ever, scientists are developing a technique to mature ovarian follicles that contain im- mature eggs, outside of the body. Advances in tech­niques like this will provide hope to the many young survivors who wish to have children after cancer.

Survivors who find themselves deal­ing with infertility after cancer treatment also have more family-planning options now than ever before. In addition to advanced biological treatments, surro­gacy and adoption are more available to cancer survivors today due to ad­vances in research and increased public awareness.

A National Effort
Young cancer survivors can discuss fertility with their local oncology treatment team, or they can contact the national fertility preserva­tion patient navigators at the Oncofertility Consortium (oncofertility.northwestern.edu), a group of healthcare providers and researchers with experience integrat­ing reproductive options into cancer treatment and survivorship. They also connect survivors to additional services within the cancer community, such as those that provide emotional and finan­cial support.

Cancer survivors can be empowered by learning about the reproductive effects of treatment, as well as their fertility-preservation options. Websites, books, social media tools, and even mobile apps now exist to educate cancer survivors. Survivors can also inform future oncofer­tility research efforts by participating in studies about their reproductive experi­ences during and after cancer treatment.

Together, the efforts of survivors, researchers, oncology teams, reproduc­tive specialists, and advocates result in more young people discussing their fer­tility options before beginning treatment. These efforts are also increasing options for survivors who were unable to pre­serve their fertility before treatment.

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