Fertility and Cancer Treatment

In our country, about 80,000 people between the ages of 20 and 39 are diagnosed each year with cancer. This is about 5% of the total number of new cancers annually. Thankfully, about 85% of these individuals will survive their cancers, but their lives may be altered in many unwanted ways. There is never a good time to have cancer, but these years are a particularly bad time. Young adults are busy finishing their educations and professional training, making decisions about relationships, and beginning to establish careers. They are not usually thinking about mortality and cancer treatments and the long-term impact of chemotherapy, radiation or surgery. One especially devastating result of some treatments is infertility.

It is very painful to lose a dream or future plans. Hearing that your cancer diagnosis may derail your hopes of a future family is terrible. Surgery for some cancers may make pregnancy impossible, and radiation to a woman’s ovaries or pelvic area may have the same result. Chemotherapy drugs can render both men and women infertile. During the crisis of diagnosis, not everyone experiences these realities as a major loss. The focus is likely on treating and, hopefully, eradicating the cancer. Sometimes, as in the case of a newly diagnosed leukemia, there is real urgency in immediately beginning cancer treatment. In some other situations, there is less time pressure, but it is always important to move forward as quickly as possible.

Unfortunately, a newly diagnosed patient should not assume that the treatment team will talk about this issue. Of course, they should, but the focus may be elsewhere. Fertility preservation is when eggs, sperm, or reproductive tissue are saved or protected so that fertility may be possible in the future. For example, it is possible to surgically move ovaries to protect them from a planned radiation field and then, later, move them back to their natural place.

For men, sperm banking is a standard and pretty easy option. It is even possible to order a kit to use at home and then store the sperm at a designated lab facility. Egg preservation is much more complicated. The process of freezing embryos or eggs is called cryopreservation, and it is important to work with a fertility specialist or IVF clinic with experience in these procedures. The process is not dissimilar from that used for women who are trying to achieve a pregnancy; in both situations the woman injects hormone medications to encourage maximum egg growth. The timing of the injections is coordinated with her menstrual cycle. After a series of injections, over the course of days, a catheter is threaded into the ovary to collect the eggs.

If the plan is to preserve embryos, the eggs are placed in a sterile lab dish with several thousand sperm. This is called IVF (in vitro fertilization). The fertilized eggs can then be frozen and thawed in the future when a pregnancy is desired. If a woman does not have a partner and is not interested in a sperm donor, the eggs can be frozen without being fertilized. These eggs can then be thawed later, injected with sperm and implanted in her uterus. As one would suspect, there are possible complications and disappointments with this process, and it is not a guarantee of future healthy babies.

A major complication is that not all insurances cover the costs of these procedures. A cycle of egg or embryo collection can cost $10,000, and that does not include the cost of storage. Since 2017, eleven states, including Massachusetts, have passed laws requiring insurance companies to cover these medically necessary expenses.

A first step is to call your insurance company and ask about coverage. If the coverage is limited, there are some resources that can help. Best known is the Livestrong Fertility Program (previously called Fertile Hope). Talk with an oncology social worker or patient navigator at your treatment center for other suggestions.

Let me conclude with hope: over the years, I have worked with people who had healthy pregnancies and babies after cancer treatment. It absolutely can happen.