Some of the most emotionally difficult conversations I have in my office on a weekly basis are those with patients who are diagnosed with cancer and come to me for fertility preservation. There is a psychological “double blow” hitting them all at once: not only is their cancer itself scary, but they are also worried that they will not be able to have children afterwards, because chemotherapy and radiation – while lifesaving – can damage their sperm and eggs.
Fertility preservation is a paramount concern for both men and women facing cancer treatments. Cancer patients are understandably focused on their treatments, but fertility preservation should not be overlooked. Here are some common misconceptions and insights that often surprise patients and even some of the medical community.
Understanding Fertility Preservation Timelines
Many people believe that the time required for fertility preservation procedures will delay cancer treatments and decrease their success. I am happy to say that this is not true; fertility preservation can be done within days for men and weeks for women.
Fertility preservation is done in conjunction with a patient’s cancer schedule and with the clearance and collaboration of their oncologist.
Men and Fertility Preservation
Chemotherapy and radiation can permanently damage a man’s ability to make sperm afterwards. Some men regain the ability to make sperm in the years following their cancer treatments, but many never do. Therefore, it is critical to freeze, or cryopreserve, their sperm samples prior to initiating any treatments. This process can happen very quickly, even on weekends, when timing is critical.
Women and Fertility Preservation
Oocytes, or eggs, are extremely sensitive to chemotherapy and radiation treatments. Making this problem even worse is that women have a finite number of eggs that must last a reproductive lifetime. The major concern is that cancer treatments will severely damage this egg supply making fertility very difficult or impossible afterwards.
Women have three main options for fertility preservation.
First, they can freeze their eggs ahead of time – called oocyte cryopreservation. With this option, women can preserve their future fertility while also maintaining their reproductive autonomy. This gives women who are not in a committed relationship at the time of egg freezing the ability to fertilize them with any sperm source in the future.
Second, if the woman is in a committed relationship, she can freeze embryos using her partner’s sperm.
Third, we can give them hormone suppression medications during chemotherapy to hopefully protect their egg supply from chemotherapy. This last option is not foolproof, and results can vary drastically, whereas egg and embryo freezing represent a much stronger, more reliable form of fertility preservation.
Download the American Society for Reproductive Medicine’s Fact Sheet on Fertility Preservation for Cancer Patients
Family-Building Options for Cancer Patients
Even patients who have already completed their cancer treatments before coming to see a Reproductive Endocrinologist and Infertility specialist (REI) can still build their family. Not all patients lose their fertility entirely and still can conceive with the help of fertility treatments even after chemotherapy treatments. Additionally, even those whose fertility has been severely compromised or lost can still utilize donor sperm, donor eggs, and even gestational carriers. There are many ways for a person to build his or her family, and we are here to help each patient find the best one for them individually.
Fertility Preservation from an Oncology Perspective
There has been a movement in the medical oncology community over the last 5-10 years to recognize the importance of fertility preservation.
The American Society for Clinical Oncologist (ASCO) states in its practice guidelines that counseling and services for fertility preservation should be immediately available for cancer patients of reproductive age. Modern oncology centers are at the forefront of helping their patients preserve their fertility by sending them to us for egg, embryo, or sperm freezing before they start cancer treatment.
How Much Does Fertility Preservation Cost?
Many states have recently passed laws mandating insurance companies to cover the costs of fertility preservation procedures for both men and women. Connecticut was the very first state in the country to pass “Melissa’s Law,” and we are very proud here at RMA of Connecticut that we had a hand in lobbying for it and getting it off the ground. New York will become the sixth state once its new mandate goes into effect in 2020.
Even if a patient does not have any insurance, or their specific policy somehow circumvents these laws, there are many resources for men and women with cancer to be able to afford fertility preservation procedures. Livestrong-Fertile Hope is a non-profit organization that provides free medications and financial support that many fertility centers, including RMA of Connecticut, work closely with.
Fertility Treatment and Cancer Risk
A very important topic is whether fertility treatments increase the risk of cancers. I am happy to report that many studies over many years have found NO LINK between fertility treatments and female breast, uterine, or ovarian cancers.
A research study was recently published that found no increased risk of breast cancer among women who had undergone IVF treatments. (“Ovarian Stimulation for In Vitro Fertilization and Long-term Risk of Breast Cancer,” Alexandra W. van den Belt-Dusebout, et al; Journal of American Medical Association, 2016). This study is one of the largest and most comprehensive studies to date on this topic and confirmed earlier research that showed similar findings.
In summary, there are many excellent fertility preservation options for both men and women these days. These treatment options can fit into even the tightest cancer treatment timelines and give hope and future family-building options for all our patients.
To learn more about fertility preservation, please call us at 203-956-2265 or fill out a request to speak with one of our physicians.