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What Cancer Patients Should Know About Fertility

March 21, 2013

The incidence of advanced breast cancer is on the rise for women aged 25-39 according to a study recently published in the Journal of the American Medical Association. While overall the incidence is low, it raises a number of concerns about future fertility for these women of reproductive age. If you’re faced with a cancer diagnosis, a referral to a fertility doctor to discuss fertility preservation before the cancer diagnosis is made can be very empowering. The survival rate for most cancers is high, and focusing on life after cancer provides hope and a sense of control at a time when you feel most out of control.

  • “First and foremost, women need to understand that they are born with their complete egg supply.” Dr. Jane Ruman, Director of Medical Affairs and Reproductive Health at Ferring Pharmaceuticals, explains that many women are concerned about whether or not their period will resume following cancer treatments, but that’s not the big issue. Even if your period resumes, you may have lost a large part or all of your permanent egg supply. Fertility is a lot more than your period, she emphasizes.
  • Cancer treatments can deplete your ovarian reserve. “The risk is greater the older you are, because you’re starting with a lower egg supply. And once they’re depleted, they’re depleted,” Ruman says. But even if you’re not going to freeze your eggs, Ruman encourages women to see a fertility doctor and get a baseline of their ovarian reserve prior to treatment and again after treatment. “It’s a lot of planning and a lot of dialogue with an expert,” she says. “And that’s really the key to fertility preservation.”
  • It’s not just radiation on your reproductive organs that can lead to infertility. Radiation around the pituitary gland or the hypothalamus, for example, can destroy the hormones that control your menstrual cycles. Whole body, abdominal and pelvic radiation, can destroy egg precursor cells, and as a result, your fertility.
  • Surgery can leave you infertile. “The second most common cancer we see presenting for fertility preservation is gynecological cancer. The risk there is surgical removal of your uterus, your tubes and ovaries,” Ruman explains.
  • Cervical cancer is most common gynecological cancer in reproductive aged women. In some instances the entire cervix and uterus may be removed, and in other instances the doctor may be able to leave a small piece of the cervix. In those women, pregnancy may be possible, but in all instances the woman will have a premature birth. These are complicated conversations a patient need to have with her fertility doctor and oncologist, Ruman says.
  • “Often there is more than one way to treat cancer effectively,” Ruman says. Ask your doctor, “Is there any alternative treatment that could be less toxic to my fertility?” Tell the oncologist, “I’m interested in having children.”
  • Fertility clinics that offer fertility preservation for cancer patients will often see them within 24 hours of their diagnosis. And they can get usually complete a cycle of egg or embryo freezing 17 days maximum, but usually 12, Ruman says. Most centers offer it at a discounted rate, and there are many programs that offer free fertility drugs. “It’s time and finances that seem to be the biggest barriers for patients to undergo fertility preservation,” Ruman says.

If your oncologist doesn’t bring up the topic of fertility preservation, you should. And ask him or her for a referral to a fertility doctor. They will work as a team to coordinate your treatment.

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