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Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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National Breast Cancer Awareness Month - Words of Hope

  
  
  

National Breast Cancer Awareness Month - Words of Hope

October is National Breast Cancer Awareness Month. To help raise awareness, the National Cancer Institute has also designated two specific awareness days during the month: Metastatic Breast Cancer Awareness Day (10/13) and National Mammography Day (10/17). In honor of Breast Cancer Awareness Day and Breast Cancer Awareness Month, Deb Chitwood from bitsofpositivity.com shared this word art freebie based on Emily Dickinson’s words of hope. I love it. Hope you like it too.

 

DChitwood Hope for National Breast Cancer Awareness Month

 

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"Saving Fertility Not Priority at Most Cancer Centers" - Catchy Headline?

  
  
  

Saving Fertility Not Priority at Most Cancer Centers

medical research on cancer and fertility preservationThat is a shocking headline. The article with this title, "Saving Fertility Not Priority at Most Cancer Centers," by Marla Paul and published by Northwestern University, reports that even the "leading National Cancer Institute-designated comprehensive cancer centers" aren't making fertility preservation a priority. At the same time, the first paragraph lists infertility as a leading concern and side effect of having cancer and undergoing cancer treatment.

 

The study by Northwestern Medicine, in essence, condemns these centers for not having policies or personnel in place to be able to give good, reliable information to patients who are already in a state of shock and distress from having received the news of a cancer diagnosis. These patients may not be able to consider anything else but the life-saving medical treatment necessary for the diagnosis of cancer. They are not necessarily capable of advocating for their own fertility. They are likely not even considering that piece of how their diagnosis will affect them. 

 

“It can be shocking for patients to find out their fertility was affected when there were potentially options that exist that were not offered to them,” said lead study author Marla Clayman, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.


Life threatening illnesses, such as cancer, must be overwhelming to everyone who has to rearrange their lives to accommodate treatment, jobs, families, and lifestyles. The side effects are often overwhelming as well, in terms of how one physically feels.

Impacts of Cancer and Infertility

Overwhelming seems like an understatement. Cancer seems to pick people up and turn them upside down, while turning them inside out at the same time. While infertility is often likened to a roller coaster, cancer may feel more like a tornado, whirling devilishly around with little possibility of catching your breath.

 

Imagine, coming through the cancer, the treatment, the side effects, and finding yourself healthy again. It happens. Often.

 

Then imagine finding out that one of the side effects is that biological children are no longer a possibility. 

 

But they could have been.

 

If you had only known that there were procedures that could have been done before cancer treatment began; that were available and appropriate and even affordable.

 

Imagine learning that a lifelong dream was now destroyed, even as the tornado lost its power. 

 

I don't know if men and women ever recover fully from cancer. Whether they consider themselves in remission for the rest of their lives or whether they consider that they've recovered. Do you expect to live the same life, have the same hopes and dreams? Do you consider yourself compromised forever?

 

Maybe you consider having a baby a frivolous issue, given the life and death possibility present with cancer. Who cares about that if you are busy participating in saving your own life? Read what Maria Clayman, lead study author had to say about that:

 

“When you think about having children after cancer, that’s a very strong way to think about surviving and thriving after cancer,” Clayman said. “It’s not just that you want to live, it’s that you want to live a life as close as possible that you could have without cancer.”


It could be a reason to live, something to hold onto as you fight off a disease. Having a baby, a healthy life and family could be the reason some men and women would hold onto with both hands.

 

If they knew.

 

Fertility Preservation: A Need for Education

 

One last bit from this very enlightening, if depressing article:

 

Fertility navigators or a designated fertility educator are key to bridge the gap between oncology and fertility. But less than one-third of the centers had someone in this role, the study reports.


Fertility navigators or educators reduce the need for oncologists to have in-depth discussions about potential fertility loss and fertility preservation, a rapidly changing field in which they are not experts.


Please. If you or someone you know has had the diagnosis of cancer or another life threatening illness, share this with them. There are options. Losing your dream of a biological family does not have to be a side effect of cancer.

 

We can help. Please let us know if you have any questions.

 

 

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Breast Cancer Does Not Mean the End Of Fertility-Dr. Spencer Richlin Comments

  
  
  

Fertility and Breast Cancer

THE GREAT AND EVEN GREATER NEWS ABOUT BREAST CANCER

 

Fertility and Breast Cancer by Dr. Spencer Richlin

As Breast Cancer Awareness Month is here, we have great news to share. Patients are surviving breast cancer with the five-year survival rate approaching 90-95%. While patients with breast cancer may or may not opt to have children, they now have more choices for family building. It is well known that female fertility may be impaired after radiotherapy, chemotherapy or surgery when treating and curing their cancer. However, there are procedures that can be done before treatment to help ensure future fertility.

Fertility Preservation through Egg Freezing

Often, treatment can be delayed to allow removal of eggs (oocytes) for future family building. In Vitro Fertilization (IVF) includes ovarian stimulation and retrieval of oocytes. Oocytes (an option for single patients who would prefer not to use donor sperm) are frozen or inseminated with sperm to make embryos. For fertility preservation, embryos and oocytes are frozen for future transfer into cancer patients after treatment or into a gestational carrier. When our cancer patients are healthy and are ready to conceive, the pregnancy rates are excellent after embryo transfer.

 

Pregnancy After Breast Cancer

 

The even greater news:

 

  • Pregnancy outcomes in cancer survivors to date have found no increase in congenital malformations or cancers in future offspring

 

  • Often cancer treatment can be delayed  to allow retrieval of oocytes for future family building

 

  • Pregnancy after cancer treatment does not increase recurrence of disease

 

  • Our patients who are preserving fertility deserve and receive the upmost respect and timely treatment during their time in our office. We have a dedicated team to make the journey seamless

 

 

  • As many cancers have excellent cure rates, the dream of having a family is still very possible. Let us help you make it happen.
 

 

 

Medical Monday - October is About Breast Health and Mental Health Too

  
  
  

Breast Health, Mental Health Awareness, and Infertility

Today, in New England, everything is turning khaki green, yellow, orange, red and maroon. And just about every brilliant shade in between.

 

Given that it’s October, everything’s also turning pink.

 

Not the trees, but just about everything else. I was watching a football game and couldn’t quite tell, but yes, they were wearing pink sneakers. Professional football players wearing bright pink sneakers.

 

Good thing that pink is not about being girly or feminine or less than masculine. Pink means something entirely different these days.

 

breast cancer awareness monthIf it’s pink, it must be October and that must mean that it’s National Breast Cancer Awareness Month (NBCAM).

 

Infertility is often likened to a life crisis similar to the one that is faced with cancer. The level of stress, exhaustion, isolation and depression, to name just a few pieces of it. Both, in their own ways, make you question your own mortality and longevity. Both make you question what you have done with your life so far and if you will be able to have your life at all, what it will look like.

 

And, just as with infertility, there are things that you can do to protect yourself with breast cancer. While you can’t do a single thing about the genes and DNA that you have inherited, even there, you can cut your losses. You can improve your odds.

 

 

Photo: SCA Svenska Cellulosa Aktiebolaget (Flickr)

 

Interestingly enough, you do it the same way you would with preventing infertility. You eat right, exercise properly, sleep enough, and find a way to deal with the ordinary stress that comes to everyone.

 

When it comes to breast cancer, you also do self exams regularly. Once a month. If you’re not sure how, ask your obstetrician/gynecologist or internist to show you. If you are over 50, the guidelines state getting a mammogram every two years, (although I’m happy that my physicians recommend every year). If you are under 50 and believe that you have significant risk factors (family history, cystic breasts, etc.), speak to your physician and find out what he/she recommends. Find out more about mammorgrams from the Office on Women's Health of the U.S. Department of Health and Human Services.

 

Infertility doesn’t excuse us from taking care of the rest of ourselves. Our bodies, minds and emotional health all still need to be attended to.

Considering Mental Health During Fertility Treatment

mental health awareness monthIn fact, this week (October 6-12) brings our attention to mental health as well, as it is also Mental Illness Awareness Week (MIAW).  If you’re in the midst of fertility treatment, have you considered making an appointment with a mental health professional? Checking in with someone who can help you in case you are really struggling? Infertility and fertility treatment is often isolating, emotionally painful, exhausting and life-altering. Without even realizing it, your life may be affected dramatically as you go through testing, treatment and disappointments when/if fertility treatment cycles are unsuccessful. None of these responses indicate mental illness; they can mean that it’s a good idea to get some help. There’s a lot of help out there and you can feel better.

 

 

Photo: faxpilot (Flickr)

 

Peer Support Groups: Ladies Night In and More

 

One way that we offer help at Reproductive Medicine Associates of CT (RMACT) is through peer support groups. The leaders (Carrie Van Steen and I) are not mental health professionals. Together, we have been leading Ladies Night In (peer support group) for almost five years. We have both experienced infertility and fertility treatment; we know what it’s like. A peer support group is a place to discuss with people that are experiencing similar challenges all the different aspects of that challenge. It’s a place to go and realize that your responses are normal. It’s a place to go where when you speak of your pain, the others in the group nod their heads. It’s a place to go to have cheerleaders that remind you that you are stronger than you may feel in that moment. It’s a place to go to have a good laugh, so good that the entire group starts laughing with you; it’s that infectious. It’s a place to go to vent and let off that steam that threatens to build up. It’s a place to go to have a question answered and an answer questioned. It’s a place to make friends. (We also have two wonderful mental health professionals at RMACT: Lisa Tuttle, PhD and Melissa Kelleher, LCSW, who offer professional therapeutic care and support.)

 

Tomorrow night (new night), Tuesday, October 8, is Ladies Night In at the RMACT Danbury office -- 67 Sand Pit Road, Danbury, CT -- from 6-7:30 p.m. 

 

This group is open to the public. It is free and we provide a lovely and delicious dinner.

 

It’s a place to come to know that you are not alone.

 

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Infertility Is Not Cancer - Angelina Jolie Has Double Mastectomy

  
  
  

Angelina Jolie's Double Mastectomy: Looking at Choices

How to Make Infertility Choices   Looking at Angelina JolieAngelina Jolie had both of her breasts removed. She writes about her decision in a NY Times op-ed "My Medical Choice" published today.  She did not have breast cancer.

 

Yet.

 

The word yet serves two purposes; two definitions.

 

Yet, she is statistically predisposed towards it.

 

Yet, she wasn’t afflicted by cancer when she made the decision to have her breasts removed.

 

She could afford to make that decision.

 

Afford.

 

The word afford serves two purposes here; two definitions.

 

One, she could afford, bear, the financial resources to have the gene testing and surgery and follow up surgical procedures done.

 

Two, she could afford to have her breasts removed because they are organs with which we can live without.

 

Just like our ovaries, uteri and fallopian tubes.

 

We can live without them.

 

But we can’t conceive, become pregnant or carry a baby without them.

 

We can do those things without breasts. We cannot breast feed after mastectomies.

 

But we can conceive and carry a pregnancy to term without our breasts.

 

I believe that Angelina Jolie made the right decision for herself and her family. Everything I’ve read has been thoughtful and insightful. Not that it’s really any of my business to approve or not to approve.

 

This was a personal decision that she made. She chose to share it publically. Not everything that she is saying resonates with the public. She’s talking about her own personal experience. While I’ve not had breast cancer or a mastectomy, a very close loved one or two, or three, have. I’m glad that Angelina’s recovery, both physically and emotionally, was so gentle. She’s clear the whole process is not so gentle. It’s painful and challenging and debilitating. Some will argue that she downplayed the recuperation; I know what I bore witness to was not what she described. Again, this was recounting of her own personal experience. And maybe it’s even only what she’s decided to share. She may not want to share each detail. Her right. Her choice.

Personal Choices During Infertility

Infertility and fertility treatment is also personal choice. Personal choice based on disease. Unlike the statistics that the gene BRAC1 represents, infertility, disease of the reproductive organs, is present when it interferes with pregnancy.

 

We come back to definitions.

 

Infertility.

 

Infertility, a disease or malfunction causing reproductive organs not to operate properly.

 

Infertility, an inability to become pregnant after one year of correctly timed sexual intercourse.

 

Infertility, the inability to carry a healthy baby or pregnancy to term.

 

Infertility, whether able to be pinpointed and specifically diagnosed or not, causing a woman the inability to become pregnant or stay pregnant to deliver a live baby.

 

Angelina Jolie made a choice. While three thousand dollars for BRAC1 testing feels outrageous and expensive and creates an elitism situation in our country, it barely registers for me.

 

Why?

 

Sounds insensitive on my part. Unintelligent even. Distinctly un-feminist.

 

Yeah, it even feels that way to me.

 

So why? Why my lack of reaction to the three grand for the testing?

 

Medical Insurance Coverage for Infertility

 

Because I sit with men and women three times a week, every week, in Fertile Yoga, in Ladies Night In, I correspond with them through the blog, who have no medical insurance for reproductive disease, also known as infertility.

 

That’s why.

 

Because we’re talking about thousands of dollars. Sometimes tens of thousands of dollars. Sometimes over and over again.

 

No reimbursement. No insurance coverage.

 

I have enough moral fiber to expand and so I will make that choice right now.

 

It’s reprehensible that testing for BRAC1 is three thousand dollars, uncovered by medical insurance.

 

It’s as reprehensible that medical treatment to correct or compensate for infertility creates the financial burden that it does, unrelieved by medical insurance.

 

Because, I’m sorry, the take away message is that if you are poor or uninsured, or underinsured or your insurance specifically excluded infertility treatment, then you are not going to be treated for your medical condition of infertility.

 

Just as if your family history would indicate BRAC1 testing is necessary and you didn’t have the three thousand dollars.

 

I’m glad that Angelina Jolie spoke up about this. I’m glad that her chances of developing breast cancer have gone from 87%, all the way down to 5%.  I’m glad that she and her family came to a decision that they could afford to support.

 

Afford.

 

Definition.

 

They had the money to have the testing done.

 

We don’t all have that.

 

Lisa Rosenthal's Google+

 

 

Once a Fertility Hero, Always a Fertility Hero - Meet Lindsay Nohr Beck

  
  
  

Meeting Heros at a Night of Hope

It's history month, at least for me, at least for this week.


Tuesday night was the RESOLVE, Night of Hope. Look below for the first line of a blog that I am repeating from two years ago. Starts with hope. Which is a favorite word of Dr. Mark Leondires, who was kind enough to invite me to the Night of Hope evening.


So a lovely, lovely night of seeing friends that I have not seen in a long time. A good excuse to dress up and hear updates on how everyone was doing. 


A rather magical evening for me. First, no traffic driving in NYC. New York City. A rainy night, rush hour and almost no traffic. Lovely. 


So we got there early.


And, as we women do, first stop, the bathroom.


There was my hero, drying her hands. We took one look at each other, started to giggle and fell into one another's arms for a heartfelt hug.


Best fifteen minutes of my evening, getting to speak to Lindsay. She is still beautiful, still sweet, still so gosh darn smart. We caught up on the last several years.


There are moments in my life when I feel my past, present and future very distinctly. That night was one of those moments.


Not an hour or so later, I heard all the details of Lindsay's past. It wasn't the first time, hearing them. Hearing them so eloguently spoken by her, reminded me of our first meeting, at her first conference. I remember how young she was, how nervous and yet so unbelievably determined and confident in her cause. Just ten years ago. 


Below was the first blog I ever wrote on a Fertility Hero. I'm leaving it largely intact, although since two years ago, Lindsay and her husband have had a third child.


From a women who had her second bought of cancer at 24 years old. Now the mother of three, having made sure that her cancer did not destroy her chances at motherhood. 


Lindsay, you are still one of my heroes. 

 

A True Story of Fertile Hope and Heroism

A story of hope.


Fertile Hope. We all have our heroes in life. Mine tend to be close to home. My parents, who defied professionals and raised a child who had a little understood disease.


My grandparents, who stood by all of us, even when barely comprehending the generational gaps between us. My Fertile Yoga students are my heroes and I get to meet new ones each week. I say it often, and I'm happy to say it again here, infertility treatment is not for the faint hearted; it takes a hero.


Oh, and my husband for being in our marriage for coming up on 26 years. He is my hero for putting up with me for so long.

 

Another hero of mine is Lindsay Nohr, a beautiful soul I am lucky enough to know. Lindsay is the founder of Fertile Hope, a not-for-profit organization dedicated to fertility preservation for men and women diagnosed with cancer. Fertile Hope is now part of Lance Armstrong's LiveStrong Foundation. (Another hero of mine, but that's a story for another day.)

 

Fertility Preservation, Courage and Foresight

 

Lindsay was diagnosed with cancer for the second time when she was 24 years old. Yes, 24; yes, for the second time. Lindsay was mature and courageous enough to look ahead, to believe that there would be an ahead and ask about her fertility for the future. And there were no easy answers. So she dug and called and asked and kept going until she found Dr. Lynn Westphal from Stamford who was willing to freeze Lindsay's eggs. This was back in 2000 when the technology was in its own embryonic stages. Freezing embryos is a very delicate process. For those men and women facing cancer treatment though, it can often be the only or best option.

 

Her thought process when speaking to her physician concerning her fertility in terms of her cancer? "He said, 'Let's focus on saving you first. If you're not alive in five years, having a baby isn't an issue,' " Beck said. "I agreed, of course. But I thought there must be something I can do now."


Lindsay was 24 years old when she was diagnosed the second time. A year later, she founded Fertile Hope and has made it possible for thousands of men and women to know what their options are when faced with cancer and seeing ahead to their own fertility. Seeing your own mortality and being hopeful enough to still see possible fertility. That's why she's one of my heroes.

 

Infertility Treatment and Cancer- The Good News

  
  
  

Tuesday Text
Dr. Leondires brought this to my attention yesterday. News we all want to hear; that trying to conceive a child and using advanced reproductive technologies do not seem to cause cancer. It's being picked up by news agencies all over the world as it's really the best news possible.

We want our families, but at what risk? Even if we were willing to take the risk of illness for ourselves, it's only fair to ask about how that would effect the child that we have brought into this world. Ironic that we even have to question that the medicine and treatments that could create a child could also create disease. How does anyone make that choice? Why should anyone have to?

The good news, as being celebrated the world over, is that you don't have to choose between a child and possible cancer. Read on to see exactly what the report has to say :

 

By Lynne Peeples  ESHRE logo

NEW YORK (Reuters Health) Dec 02 - Fertility treatment may not be tied to an increased risk of cancer, suggests a new study from Sweden.

Some prior studies had suggested that fertility drugs might be linked with breast, uterine and ovarian cancers, but the numbers of women followed in these studies were small, said lead researcher Dr. Bengt Kallen of the University of Lund in e-mail to Reuters Health.

In new research reported online November 18th in Human Reproduction, Dr. Kallen and colleagues analyzed registry data from 1982-2006 on 24,000 women who gave birth after in vitro fertilization (IVF). They compared rates of cancer in these women and in 1.4 million women in the general Swedish population who also gave birth in those years.

Fewer than 2% of women in the IVF group developed one or more cancers during an average follow-up of 8 years, vs close to 5% of the control group.

After accounting for maternal age, number of previous pregnancies, and smoking status, the overall risk of cancer was about 25% lower for women who had IVF.

"A couple who needs IVF does not have to be afraid that the hormone treatment used -- at least those used in Sweden -- will carry a risk for the woman to develop cancer," Dr. Kallen told Reuters Health.

The risk of ovarian cancer was more than twice as high in the women who had IVF as in those who didn't, however. Dr. Kallen suggests this may be due to abnormalities in ovarian function, which both increase the risk for infertility -- and therefore the need for IVF -- and the risk for cancer.

"The risk for two common cancers, breast and cervical, was significantly lower than expected," Dr. Kallen said.

Dr. Kallen also offered two possible explanations for these surprising findings: women who got IVF may have been healthier than average, or perhaps more likely, IVF-treated women may undergo more mammography and cervical exams.

The only fertility drugs currently used with IVF in Sweden are gonadotropins. Prior to the mid-1990s, these drugs were used in combination with another treatment, clomiphene.

Gonadotropins are also the primary fertility hormones prescribed today in IVF clinics across the U.S. Clomiphene is used only very rarely, Dr. Helen Kim, Director of the In Vitro Fertilization Program at The University of Chicago, told Reuters Health.

Despite some concern regarding the relatively homogenous population of Sweden, Dr. Kim - who wasn't involved in the study - believes its findings should be fairly generalizable.

Infertility is Not a Life or Death Situation, Or Is It?

  
  
  
  Infertility is not cancer. It is not heart disease. It is not neurofibromatosis. And we should feel very grateful that it is none of those things. It is not life and death.

Hmmm.... Or it is? It's certainly the inability or a challenge to bring life into this world. It can be the death of the dream of a biological child or family. The death of a family and offspring created between you and a partner. I heard it put this way last weekend, "its like having a small death each month".

Our sense of mortality is sorely tested when faced with infertility. While it's not our own death that we are facing, there is no question that we have to consider the finish of our family lineage. Our family DNA, certainly, but beyond that as well. Our traditions, rituals, religion. Our memories, where and who do they go to? How do our memories of a beloved Grandmother or Great Uncle go on living and breathing without children to pass them on to? Who will pass those things on? And ultimately, who will pass on memories of you or me? This is the mortality that we face. That we are it. The end of the line.

If you are rolling around the word selfish or narcissist in your brain, stop right there. Like other living beings on the earth, we have an instinct to procreate. These days it's not so much for extra hands in the fields, helping us harvest. Maybe it was never entirely that. There is the unmistakable, undeniable urge to love and nurture that is associated with wanting a child, a family.

How lucky we are to live in an age and time where there are so many ways to create a family. To have a child in our lives that may not be of our own biological lineage, may not even live in our homes, but live in our hearts.  Facing infertility head on, allowing yourself to grieve for what you wanted that may not be possible, acknowledging losses is a clear path to moving forward. Grieving is a healthy, normal process for dealing with loss. And infertility does create loss, no question about it.

If you are feeling these losses, if they are feeling enormous, consider getting some help. That help may come from traditional therapy (Lisa Tuttle, PhD and Jane Elisofon, MSW are wonderful therapists who specialize in infertility); help can come in less traditional ways as well. Perhaps a dance class, drawing class, golf lessons. Something that puts you back into feeling alive, with growth and new potential. Low level depression can sap energy and make you feel that almost everything beyond the basics is impossible. Definitely the right time to call either Lisa Tuttle or Jane Elisofon or a therapist in your area if that's true.

What does infertility feel like to you? Sharing with others may help them feel that they are not alone and may create a sense of relief for you in expressing yourself.

One of My Infertility Heroes- Lindsay Nohr and Fertile Hope

  
  
  
  A story of hope. Fertile Hope. We all have our heroes in life. Mine tend to be close to home. My parents, who defied professionals and raised a child who had a little understood disease. My grandparents, who stood by all of us, even when barely comprehending the generational gaps between us. My Fertile Yoga students are my heroes and I get to meet new ones each week. I say it often, and I'm happy to say it again here, infertility treatmentis not for the faint hearted; it takes a hero.

Oh, and my husband for being in our marriage for coming up on 26 years. He is my hero for putting up with me for so long.

Another hero of mine is Lindsay Nohr, a beautiful soul I am lucky enough to know. Lindsay is the founder of Fertile Hope, a not for profit organization dedicated to fertility preservation for men and women diagnosed with cancer. Fertile Hope is now part of Lance Armstrong's LiveStrong Foundation. (Another hero of mine, but that's a story for another day.)

Lindsay was diagnosed with cancer for second time when she was 24 years old. Yes, 24, yes, for the second time. Lindsay was mature and courageous enough to look ahead, to believe that there would be an ahead and ask about her fertility for the future. And there were no easy answers. So she dug and called and asked and kept going until she found Dr. Lynn Westphal from Stamford who was willing to freeze Lindsay's eggs. This was back in 2000 when the technology was in its own embryonic stages. Freezing embryos is a much more delicate process than freezing embryos; one far less successful. For those men and women facing cancer treatment though, it can often be the only or best option.

Her thought process when speaking to her physician concerning her fertility in terms of her cancer? "He said, 'Let's focus on saving you first. If you're not alive in five years, having a baby isn't an issue,' " Beck said. "I agreed, of course. But I thought there must be something I can do now."


Lindsay was 24 years old when she was diagnosed the second time. A year later, she founded Fertile Hope and has made it possible for thousands of men and women to know what their options are when faced with cancer and seeing ahead to their own fertility. Seeing your own mortality and being hopeful enough to still see possible fertility. That's why she's one of my heroes.

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