Cancer Treatment Now Includes Fertility Planning

(WOMENSENEWS)–A young woman raised her hand at the end of a seminar for young cancer survivors.

It was last spring, during an I[2]Y (or "I’m Too Young for This!") meeting, and the seminar was on post-cancer family planning.

She said she received radiation to her abdomen during treatment for cancer in her teens and, as a result, was being told that her eggs were most likely not viable, though she is well within child-bearing age. She was upset that fertility issues were not discussed with her and her family at the time of her treatment.

Until recently, standard cancer treatments have not included female fertility preservation as a joint concern.

If cancer was discovered, regardless of the patient’s age, it was treated as quickly and as aggressively as deemed necessary (chemotherapy, surgery, and radiation being the primary tools), and that was that; fertility was not generally a part of the conversation.

But as awareness grows about the potential effects of treatments on female fertility, and as fertility-preservation techniques become more sophisticated, these discussions are changing.

Several programs now help girls and women who are facing cancer treatments to retain their fertility options for the future.

One of them, the "Fertility Rescue" program of the Sher Institute for Reproductive Medicine (with locations in Illinois, Texas, Nevada, Pennsylvania, New Jersey, New York, and California), offers free egg-retrieval cycles for women of childbearing age who are facing treatments that might compromise their fertility.

The eggs are then frozen and stored, to be thawed at the time that a pregnancy is desired. This is an important resource given that each egg-retrieval effort can cost $10,000 and few insurers offer coverage.

"The main costs are our fees, which we waive," says Sher’s Dr. Drew Tortoriello. "The medications are being donated by the pharmaceutical companies. We also do not charge for storage for the first two years."

New Focus

The Sher program’s focus on egg freezing, as opposed to the creation and preservation of embryos, is relatively new.

Embryo creation, first practiced in the 1980s, was the norm because eggs stood less of a chance of surviving the required preservation processes.

"The big barrier to egg-freezing technology was the poor survival rate upon thawing the egg," Tortoriello explains. "We now use a technique called vitrification that allows 98 percent of the eggs we thaw to survive."

Eggs contain a great deal of water, which can make freezing processes complicated.

When eggs are frozen, ice crystals can form within them and destroy the cell’s structure. Vitrification freezes the egg so quickly that ice crystals don’t have time to form.

Live-birth statistics with this method are promising, says Tortoriello: "The once large disparity between the success of embryo and egg freezing has narrowed, and they are similar in their outcomes. For every chromosomally normal egg we freeze, the chance of the woman later having a baby with this egg is over 35 percent."

This is an important development for women who don’t yet have a partner with whom they are planning a family (or for same-sex couples who have not made arrangements with a sperm donor). But even women in long-term heterosexual partnerships have reason to consider freezing eggs rather than embryos. Anna, whose name has been changed here to protect her privacy, was diagnosed with early-stage breast cancer at age 34. She offers an invaluable perspective on this issue.

"When I was diagnosed in 2006," she says, "I was on the brink of attempting to have a second child; literally days away from starting to try to get pregnant. Although the diagnosis was startling, I was very confident I would survive the cancer but quite devastated that I might not be able to have more children. My husband and I decided to pursue fertility treatments, and we successfully froze 15 embryos. I understood the risks of freezing eggs, and with complete security in my marriage of 11 years, I had no reservations about freezing embryos."

Unexpected Divorce

What happened next–the unforeseen end of her marriage–shocked Anna and jolted her plans for the future. "A year later, my husband left," she says. "In subsequent lengthy divorce negotiations, I was not allowed to have the embryos."

This is not uncommon in such disputes, as DNA cannot be used without an affected individual’s consent. Both parties responsible for the creation of an embryo, whether part of a couple or not, must agree on the possibilities for its use.

Some fertility doctors encourage their patients to get as much legally addressed and resolved as possible along these lines at the time that embryos are created; but a patient heading into cancer treatment might understandably not find time to meet with a lawyer in the midst of already overwhelming medical appointments.

"The cancer was a very difficult thing to live through," says Anna. "The divorce was much worse. But losing the embryos was like having my heart punched into pieces. It’s been four years and my life has certainly moved on, but I will forever regret not having eggs that I could use–whether to carry a pregnancy, to use a surrogate, or even to choose to donate the eggs. If there is one thing I would say to women considering their options, it is this: Life changes in the blink of an eye. Your husband may not be your husband next year or when you finally use those eggs. People die. People divorce. Remember that with your cancer diagnosis and your fertility concerns, you need to preserve fertility for yourself and no one else."

Women who, for various reasons, were not able to take fertility-preservation measures before their cancer treatment can find themselves in a difficult position. Most presentations, statistics, and programs focus on what to do before cancer therapy, not after.

Fertility preservation might not occur before treatment for many reasons. In some cases of aggressive cancer, doctors would prefer not to allow time for fertility measures, which must be timed properly to a woman’s cycle. Some women can’t afford the measures, which underscores the importance of the Sher program and the need for more. There is also the patient’s age: Egg freezing can only be performed when a patient is old enough to ovulate.

If egg retrieval is not possible after treatment, a woman may be able to use a donor egg.

And while the Sher program and others focus on women who have not yet been through treatment, it is worth discussing one’s particular circumstances with program representatives to see what options and assistance might be available.

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Pamela Grossman is a Brooklyn, N.Y.-based writer, editor, and medical advocate and an active member of the Young Survival Coalition and SHARE.