When Marcia Donziger, 54, was first diagnosed with stage 3 ovarian cancer, she was waking up from surgery 27 years ago.
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“At the time, I was newly married, ready to start a family,” she says.
But she began experiencing bloating, a squeezing pain around her waist, painful urination and other symptoms for months before that. After Donziger scheduled an appointment with her doctor, an exam revealed a tumor on one of her ovaries.
“Immediately, I panic a little and I say, ‘Could this be cancer?'” she recalls.
The doctor put her mind at ease, informing her that she was too young to have cancer and that she simply needed to undergo a procedure to remove the tumor from her ovary. Although she would have one less ovary, her doctor reassured her that she would still be able to have children.
But much to her surprise and dismay, that was not the case. When Donziger woke up from surgery, her doctor notified her that the tumor was, indeed, cancerous and they had to perform a life-saving operation: a complete hysterectomy, a surgical procedure in which the entire uterus is removed. This effectively eliminated her options of conceiving naturally.
“That avenue of having my own kids was dramatically cut off without my knowledge,” she says.
However, thanks to fertility assistance options for cancer patients, Donziger was able to build a family that now includes twin boys.
Cancer Diagnosis and Fertility
Receiving a cancer diagnosis can be shocking and hard to digest. If you’re interested in having children, learning your fertility may be affected by cancer only piles on to an already heavy load.
When a cancer diagnosis is made, there’s usually a multidisciplinary team involved and a series of consults and related decisions that need to happen.
Fertility preservation should be considered immediately, but this may not always be the case.
“It depends on the cancer and treatment,” says Dr. Eric Knochenhauer, director of reproductive endocrinology and infertility at Staten Island University Hospital and director of Island Reproductive Services in Staten Island, New York.
If the cancer at the time of diagnosis is advanced, treatment may need to start immediately.
In a fertility preservation consultation with a reproductive endocrinologist, patients with a new diagnosis are guided to better understand what their diagnosis means for their future fertility and, if applicable, understand what their fertility preservation options are.
“It’s totally valid to choose not to pursue any fertility preservation, but it’s really important that they get the information,” says Dr. Katherine Cameron, an assistant professor of reproductive endocrinology and infertility at Johns Hopkins School of Medicine and director of third-party reproduction at the Johns Hopkins Fertility Center in Baltimore.
[Read: Where to Go for Cancer Treatment.]
[Read: How to Find a Good Fertility Clinic.]
How Cancer Treatments Affect Fertility
The three main cancer treatments that impact egg supply or sperm production are:
— Radiation
— Certain chemotherapy drugs, particularly alkylating agents
— Surgery
Radiation
Radiation therapy uses high doses of radiation to kill cancer cells or slow their growth. When radiation is done near the abdomen, pelvis region or spine, it can also damage healthy cells in your reproductive organs. The impact of radiation depends on the radiation dose, frequency and proximity to reproductive organs.
Patients who are receiving a bone marrow transplant or stem cell transplant are also at high risk of having their fertility impacted due to total body radiation.
For males and females undergoing radiation, a protective shield is commonly placed over reproductive organs to prevent damage from radiation therapy. However, the decision to use a protective shield depends on the specific treatment plan and individual patient factors, and it may be used when the patient is undergoing combined treatment with radiation and chemotherapy.
Chemotherapy
Chemotherapy drugs kill cancer cells in the body by targeting cells that are rapidly growing or dividing, but this causes other side effects, including hair loss, nausea and vomiting.
With patients of reproductive age, chemotherapy can also cause temporary or permanent infertility.
“The cells in the ovaries are constantly undergoing cell division, so that’s why they are a target for those chemotherapy drugs,” Cameron says.
Chemotherapy can damage ovarian follicles, reducing ovarian reserve and potentially causing premature ovarian failure or early menopause, resulting in difficulty or inability to conceive.
Surgery
Depending on the type, stage and site of the cancer, surgery is often performed to remove the cancerous tissue. Chemotherapy and radiation may be part of the post-surgical treatment as an adjuvant therapy to destroy any remaining cancer cells and reduce the likelihood of the cancer returning.
Surgical procedures may be considered for gynecologic cancers, like uterine cancer, ovarian cancer or cervical cancer. These options may involve removing part or all of the uterus, one or both ovaries or fallopian tubes, abnormal cervical tissue or the entire cervix.
Surgical options in men may be considered for certain cancers such as testicular cancer, which may involve removal of one or both testicles, or prostate cancer, which may involve removal of part or all of the prostate gland.
[READ: Worst Cancer-Causing Foods.]
Navigating Emotional Challenges
Receiving a cancer diagnosis is an isolating experience in and of itself, but having to navigate the disease’s impact on fertility can be especially difficult.
That’s why being surrounded by a supportive community is essential to the process. Many hospitals offer cancer support groups, patient support programs and social work to patients to help throughout the various steps of their cancer diagnosis, treatment and recovery.
Hospital communities and services play a pivotal role in the patient journey, providing a range of benefits, including:
— Sense of community
— Emotional support
— Coping strategies
— Educational information and resources
— Practical assistance, like navigating insurance or arranging transportation
“Thankfully, I met an oncology social worker that year who took me under her wing,” Donziger adds. “She helped me intentionally grieve the loss of my unborn child.”
There are several national organizations that provide support, counseling, opportunities for virtual or in-person meetups and other resources to patients. These include:
— CanCare
For Donziger, outside resources came at the right time: A year after her hysterectomy, she and her husband divorced.
“Unfortunately, my husband didn’t like the fact that I couldn’t have children anymore,” she says. “I really felt like I was damaged goods and I wasn’t bringing the full picture of womanhood to a potential partner.”
Years later, back on the dating scene, Donziger also enlisted the help of a therapist to help her cope, rebuild her confidence and navigate her new normal.
[READ: Mental Health Support Groups: Pros & Cons.]
Having a Biological Child After Cancer
Following a cancer diagnosis, there are many ways to preserve your fertility and have healthy biological children.
When you can consider pregnancy after cancer treatment
Determining whether or not someone is ready to conceive after cancer treatment isn’t just an answer purely from a fertility standpoint.
Many factors are considered to help guide a patient who wants to try to get pregnant, such as:
— Type of cancer
— Treatment type, dosage and duration
— Age
— Recovery time
— Reproductive health
— Overall health and well-being
Depending on their health and recovery status, individuals or couples may be able to conceive naturally. For others, they may have opted to preserve their fertility before receiving cancer treatment and will need to undergo assisted reproductive technology procedures, such as in vitro fertilization, or IVF.
If the patient is pursuing fertility treatment options, fertility specialists will work with a multidisciplinary team of providers — such as the patient’s oncologist and maternal-fetal medicine physicians — to provide personalized guidance and recommendations.
Fertility preservation
Fertility preservation is the process of saving an individual’s eggs or sperm to allow them to have biological children in the future.
For women, this involves taking hormones that allow multiple eggs to mature at once, then suctioning the eggs from the ovaries through a tiny tube so that they can later be used for IVF. Whether they’re undergoing egg freezing (oocyte cryopreservation) or embryo freezing (embryo cryopreservation), the process can take a couple of weeks — time that many cancer patients don’t have.
“In a perfect world, we have had the conversation and have potentially pursued fertility preservation prior to cancer treatment — if that is important for the patient,” Cameron says.
Doctors may also preserve parts of the ovary itself, surgically removing small strips of the organ tissue and freezing them before cancer treatment begins. After treatment, when a woman is ready to become pregnant, the tissue is thawed and sewn back into the ovary to stimulate ovulation.
For males, freezing sperm is generally a relatively quick process. Sperm cryopreservation begins by collecting a semen sample, usually done through masturbation to a sterile container if the male is able to ejaculate.
Male patients who aren’t able to produce a semen sample may benefit from a more routinely done procedure, testicular sperm extraction, through which sperm are retrieved from a biopsy of the testicles.
Financial considerations and resources
Fertility treatment options can be costly, especially if they’re not covered under an insurance plan.
Programs that provide financial support for cancer survivors or people with a new cancer diagnosis to pursue fertility preservation include:
— LiveStrong, which provides medications and discounted egg and embryo freezing prices. LiveStrong also offers additional resources if you’re in need of financial assistance. Many hospitals and clinics also have financial counselors or social workers available to help you navigate financial assistance.
— Heart Beat, a program from Ferring Pharmaceuticals that provides financial assistance for eligible patients.
Family-Building Choices After Fertility Loss
There are several options to consider building a family, including:
— Adoption
— Egg or sperm donation
— Foster care
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No matter what option you consider, finding an experienced agency with a track record of success and reliable references is important.
Grieving the loss that comes with infertility before thinking about a different route to parenthood is also an essential step in the process.
“‘If you don’t grieve the loss of your unborn children or the children you thought you might have, you’re not in this healthy position to take on other children that may come your way,'” Donziger recalls her oncology social worker telling her.
While Donziger and her now husband considered several options, they felt that surrogacy with an egg donor was the right choice for them. They now have 18-year-old twin boys who are getting ready to graduate from high school this month.
Challenges
Some challenges that may come with alternative paths to parenthood include:
— Financial strain
— Emotional drain and uncertainty
— Complex decision-making
— Disclosure and privacy concerns
— Legal or logistical hurdles
— Self-identity around parenting
While she made peace with not having a biological connection to her children, Donziger still struggled with the process of finding an egg donor.
“Looking for an egg donor is like a dating website,” she says, describing she felt almost like they were finding “young women to replace me genetically.”
Additionally, after starting the egg donor process, the couple had two egg donors in a row change their mind after matching. After months of uncertainty, in the end, the third time was the charm.
Questions to Ask About Fertility After Cancer Treatment
It’s important to talk with your oncologist and reproductive endocrinologist about how cancer treatment will affect your fertility and what your options are for fertility preservation. Whether or not building a family is important to you right now, knowing what your options are will allow you to make an informed decision in the future.
Questions you should ask your doctor include:
— What impact will my cancer treatment have on my fertility?
— What fertility preservation options are available for me?
— How urgent is my cancer treatment? Can I delay it to undergo fertility preservation?
— What is the success rate of fertility preservation and IVF for someone with my type of cancer?
— What are my chances of conceiving naturally after cancer?
— What are the potential risks of pregnancy after cancer treatment?
— What support groups or counseling services are available through the cancer center for patients navigating fertility and cancer?
Bottom Line
Despite challenges around fertility after cancer, with the right support and guidance, advances in medicine offer hope to individuals seeking to build a family.
Whether through fertility preservation options, assisted reproductive technologies like IVF, or family-building options like adoption and surrogacy, parenthood after cancer is within reach.
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Fertility After Cancer originally appeared on usnews.com
