Cancer and pregnancy. Two words many people would not put in the same sentence. But with a growing number of cancer survivors still in their reproductive years, many people are often considering cancer treatment and how it will affect their future ability to have kids.
Thanks to advances in cancer treatment, the rate of survival from childhood and adult cancers has increased steadily over the years. The five-year survival rate is greater than 80 percent for both childhood cancers and adult women of reproductive age. In fact, 1 in 400 adults are cancer survivors.
Chemotherapy, radiation or surgery can affect the number and quality of eggs within the ovary. Treatment can also cause damage or loss of reproductive organs. The likelihood of a cancer survivor having a significant decrease or complete loss of fertility through ovarian failure depends on her age, type of cancer and specific treatment plan. Fertility preservation (FP) serves the purpose of preserving, expanding and restoring the reproductive future of cancer patients.
Why is it important?
Fertility issues are emotionally challenging, no matter the cause. One study found that 55 percent of cancer patients felt having a child was the most important event in their life. In addition, 64 percent said their fertility was the single most concerning issue about their treatment. These concerns are valid and understandable. In fact, the loss of fertility from cancer treatment is associated with depression, increased stress, sexual dysfunction and lower physical quality of life.
To add to the burden, research shows that talking about the risk of cancer-related infertility is an important but inadequate part of the discussion at the time of diagnosis. A lack of information at the time of diagnosis and treatment planning are associated with negative mood and increased stress. Sadly, 33 percent of women report dissatisfaction with the quality and length of discussion about cancer-related effects on their reproductive health. And 73 percent of childhood cancer survivors say they received insufficient information when they were diagnosed.
What options are available?
The American Society of Clinical Oncology (ASCO) recommends that doctors assess all patients diagnosed with cancer for the risk of infertility. The ASCO also advises that interested patients at risk for treatment-induced infertility see a specialist to discuss their options. Cancer patients should talk openly about these things with their doctor.
There are established methods of FP for adult women and adolescents who have undergone puberty. Egg and embryo cryopreservation, or freezing, are two options. For some patients, ovarian transposition and fertility-sparing surgeries may be available. For pre-pubertal children, investigational methods such as ovarian tissue freezing may be an option. For men, sperm preservation is a well-established method for FP and can be done through their local sperm bank or fertility specialist.
Learning you have cancer is stressful and overwhelming. This is why making decisions about FP at the same time is challenging. Counseling about FP options is incredibly beneficial, even if women choose not to proceed with preservation before their cancer treatment. Studies show that counseling results in feelings of hope and profound relief while giving many patients a reason to live. Furthermore, those who proceed with FP treatment often feel it helps them cope and stay positive.
There is still a lot to learn about FP and family building after cancer. Ongoing research is offering more information about the effects of cancer treatment and methods of FP. In addition, the cost of some treatments has historically been a barrier for many patients. However, Maryland recently became the third state to enact a fertility preservation law.
Many factors affect the chance of becoming pregnant after fertility-sparing surgery or egg/embryo freezing. If you’re a cancer patient facing these decisions, it’s important to talk to your doctor about the FP options that are best for you.