PART 4 IN A SERIES
When you hear “You have cancer,” having a baby may be the last thing on your mind. For people dealing with cancer, there are many concerns, and fertility may not be one of them. It can depend on their age and how aggressive their cancer is. But many people who are dealing with cancer prior to or during their prime child-bearing years need to consider their options.
Although cancer is serious, more people are living with it and past it than ever. For both men and women, fertility can be affected by cancer treatment. Women are born with a certain number of eggs, and if they are damaged, more eggs cannot be created. For men, they benefit from the process of new sperm being produced daily, except in cases where they have surgery or radiation on their reproductive system. But, given that many of the causes of infertility are unknown or combinations of issues, challenges can add up on both sides.
When Crystal Silins was diagnosed with breast cancer at age 29, she and her husband had been trying to have a baby.
“We had only been married about a year and a half, and were trying for a year leading up to being diagnosed with breast cancer. I even had a miscarriage six months before my diagnosis,” she says. It was challenging to put their attempts to start a family on hold.
Silins says that her oncologist mentioned preserving eggs, but also the serious risks of waiting to have surgery and starting treatment.
“Going through a cycle of fertility preservation would’ve taken additional time and drugs that my oncologist preferred me not to have to take based on the type of cancer I had. On top of all that, it was going to cost me a few thousand dollars that I didn’t have at the time, or was unable to come up with quickly. We opted to focus on my cancer and hope for a family once my fight was through,” she says.
Fertility Consults
Cancer professionals are focused on fighting the cancer, and sometimes feel awkward about the fertility conversation. Dr. Silvina Bocca, a reproductive endocrinologist with Eastern Virginia Medical School in Norfolk, Virginia, says that frustrations with these conversations are common.
“It can be very gratifying to talk about it, but unfortunately, it’s often overlooked. We do acknowledge the tremendous amount of stress they are under. They may say ‘I need to go get my port in, but thanks for taking the time to talk about this,’” Bocca says.
There are a number of factors that affect conception, including age, fertility before cancer, type of cancer and stage of cancer, so each person’s experience may be different.
“The young adult cancer survivors group, who are mainly in their early to mid-20s, are starting relationships and want to know what their options are. The younger the patient, the better the chances their ovaries will recover. But the length, type and dose of treatment all affect the recovery of ovarian function,” says Bocca.
While it was once thought that treatment such as a bone marrow transplant or high doses of chemotherapy would automatically put a female patient into early menopause, there is now more awareness and fertility may be preserved in some cases. But it’s not just a female concern—just like in couples without cancer, male infertility is common, so having the conversation with the health care team prior to his cancer treatment is an important part of knowing what options are available, too.
“Fifty to 95% of males with cancer will have persistent problems with their fertility after cancer treatment. However, it is the type of treatment rather than the type of cancer that has a greater effect on fertility,” says Dr. Victor Brugh, a male infertility specialist with Urology of Virginia. “I recommend that all reproductive-aged men be counseled for fertility preservation prior to starting cancer therapy. It’s that simple.”
Fertility counseling is often as simple as a conversation with a specialist. Besides preservation of eggs or sperm, there are also options such as donor eggs or donor sperm, in addition to surrogacy and adoption.
“They should obtain a consult and not wait. Most patients with infertility are successful conceiving. Some need very little help – thyroid adjustment or IVF but the majority can conceive, even those who may have chemotherapy,” says Bocca.
Cancer Challenges
Cancer brings many new experiences: managing appointments, dealing with side effects, dealing with emotional and financial concerns. The additional concerns about fertility and family planning can be stressful.
For Candace Wohl, her uterine cancer made bearing a child impossible after her hysterectomy. For their family, the best option was surrogacy.
“I didn’t have the experience of pregnancy, the fluttering kick, the swollen ankles or the rolling stomach—so I can’t relate to those. But when she arrived, we were so ready to be her parents,” Wohl says.
For the Silins family, it was a weighing of the physical risks and benefits and cost considerations.
“I didn’t realize how much the chemo could affect my fertility. I was in fight mode for myself during my time of diagnosis, and felt we could always just circle back to the fertility stuff once we got chemo out of the way,” Crystal Silins says. “We really believe adoption was the way to go to start our family considering all circumstances.”
Today, their daughter Brianna is 18 months old and they would love to give her a sibling.
Future Fears
Particularly for young women with breast cancer, it’s important to consider the hormones that feed their tumors may be the same ones affected by fertility treatments and pregnancy: estrogen and progesterone. The medications taken post-cancer treatment
also present risks to a fetus, so would have to be discontinued.
Among many tough choices, Silins says that the hardest part is accepting that they weren’t able to have a baby, and still may not be able to even with the help of a fertility specialist. In addition to the stress of cancer, the long-term effects of treatment and the process of adoption, there’s another concern for parents who are cancer survivors.
“The ever so popular ‘Will my cancer come back?’ I’m only 33, and although I had the bilateral mastectomy, chemo, and radiation, will it return somewhere else in my body? I try to not dwell on it and just live everyday as happily as I can. I make my moments count with Brianna, and no matter what happens, she’ll always know how loved she is, and I’m thankful to be a mother. I just hope I am around long enough to see all her milestones in life, or at least to see her graduate high school,” Silins says.
The challenges of infertility and cancer overlap in an intricate way, but there are advances being made in both areas, offering hope to many.
