Fertility-Preservation Options for Cancer Survivors
by Leslie Ayensu Appiah, MD
“My partner and I were married a year ago and have been trying to have a child. I haven’t had a menstrual cycle in several years, and I wanted to make sure everything was fine. I’m not sure if you have my records, but I was treated for Ewing sarcoma when I was seventeen.”
This is an opening statement I often hear in my practice as an obstetrician and gynecologist. Woven through those sentences are undertones of hope and an almost imperceptible amount of apprehension. Most women know that not having menstrual cycles is not the norm and that it may be a sign of infertility; however, in the busyness of life, they push it to the back of their minds.
Over the last few decades, breakthroughs in science and medicine have improved cancer survival rates. The focus has now appropriately shifted to quality of life. The ability to have children and build a family is an important quality of life indicator for many survivors. Fertility preservation improves the chances of having children after cancer treatment; therefore, it is an important – yet sometimes overlooked – aspect of cancer care.
When to Talk about Fertility
A cancer diagnosis can be overwhelming. It can be difficult to “hear” or process discussions about how your diagnosis may affect your future fertility right after hearing the words “you have cancer.” This is why cancer survivors should have a separate conversation with a reproductive specialist after their initial discussion with the oncologist. Fertility-preservation counseling should occur within days of your initial cancer diagnosis so that fertility-preservation options can be implemented in a timely fashion.
Once you are cleared to attempt conception after cancer treatment, there is no additional risk of birth defects or miscarriages. Equally important, pregnancy does not adversely affect overall survival.
Know Your Options
The best time to implement fertility preservation techniques is before you begin cancer treatment, as this is when you have the most options available and sperm and egg quality are at their best.
Standard fertility preservation options include egg, embryo, and sperm freezing. Testicular and ovarian tissue freezing are investigational options for survivors at high risk of infertility who are not candidates for standard therapies or who cannot delay cancer treatment to pursue those options. Several pregnancies worldwide have been achieved from ovarian tissue freezing, therefore making it a very viable option.
The best time to implement fertility preservation techniques is before you begin cancer treatment.
Many survivors express concern that pursuing fertility preservation will delay their cancer treatment. However, the two weeks required for women to freeze eggs and embryos is not prohibitive in most cancer types, particularly as newer technologies have been developed to quick-start the process. For men, sperm banking only takes a few days to coordinate and poses no delay. Similarly, ovarian and testicular tissue freezing require no delay.
For those survivors who cannot pursue fertility preservation prior to cancer treatment, options remain available. Survivors at high risk of infertility who have undergone a cycle of chemotherapy may still freeze testicular or ovarian tissue. Additionally, recent studies have shown that temporary suppression of ovarian function can improve pregnancy success rates in women with certain types of breast cancer.
Once Cancer Treatment Ends
Monitoring reproductive function after cancer treatment is an important aspect of survivorship. Regular menses do not predict fertility; therefore, medical evaluation is needed in survivors at risk for fertility loss due to cancer treatment. Routine follow-up with a reproductive specialist can help identify whether you are at risk and help you develop a long-term fertility plan.
There is currently no gold standard for monitoring fertility after treatment; however, a combination of blood work and ultrasounds may be the best course. For those survivors who have diminished reproductive function, implementing fertility preservation techniques after cancer therapy may be warranted.
Not every cancer survivor wants to have children. However, family building can be a rewarding aspect of survivorship for those who desire it. Moreover, regardless of their parental aspirations, cancer survivors experience less regret and greater quality of life when they talk to their doctors about their fertility preservation options, even if none are pursued.
Cancer can do many things, but we can’t allow it to shatter hope. Through a multi-disciplinary team approach, most cancer survivors can hold on to the very real hope of becoming parents after cancer treatment.
Dr. Leslie Ayensu Appiah is a board-certified obstetrician and gynecologist with specialty training in pediatric and adolescent gynecology, as well as expertise in fertility preservation. She is an associate professor in the Department of Obstetrics and Gynecology and the director of Oncofertility and Pediatric and Adolescent Gynecology at the University of Kentucky College of Medicine in Lexington, KY.
This article was published in Coping® with Cancer magazine, September/October 2016.