When you receive a diagnosis of cancer, the last thing you need is another research project.
You may find yourself actively investigating the treatment options for your type of cancer, seeing multiple specialists and trying to cope with the huge emotional impact it has on you and your family. But in the mix should be a talk about fertility preservation. You should know if your surgery, chemo, or radiation will alter your fertility or render you infertile. Since survival rate after cancer diagnosis is getting better every day, especially for young healthy women with an early stage diagnosis, thinking about the long term goals for your life is critical at this juncture.
Data indicates that only 61% of California women received fertility counseling from their oncologist prior to cancer treatment that could render them infertile. A recent study done by Dr. Joseph Letourneau revealed that patients who received chemo or pelvic radiation and were counseled by their oncologist about fertility preservation options had a better psychological and physiological health score than those not counseled. In addition, the Decision Regret score was 10.8 compared to 12.6 in women who had no counseling. For women who saw a fertility specialist, their score was 8.5 and for those who actually pursued treatment for fertility preservation, the score was 6.5. This is on a 5-25 point scale where a 3 point change is clinically meaningful.
There are many websites that can help educate you about your options, but usually they will not be able to tailor the situation to your specifics- are you single, dating, married? Did you want 1 child, another child, or just the potential to try for children? How much time to you have to do this thing called “fertility preservation”? How much will it cost? How much MORE time off work will you need to take? And of course, the most important question: which treatment is best for me?
Seeing a reproductive endocrinologist who practices IVF will allow you not only to get the most up to date information, but to initiate treatment immediately. Coordination with your oncologist is key, and arriving at the appointment with paperwork in hand about your disease, the extent of organ involvement, the hormonal dependence, and the timeline for chemo or radiation (or additional surgery) will help the REI doctor develop a more appropriate treatment plan.
It is helpful to have a friend or family member with you to take notes. There is a lot to remember and you have been through a lot already!
It is important to understand the chemo and radiation can cause the ovary to run out of good eggs prematurely. Radiation may also cause problems with the uterine lining and muscle that hold the pregnancy. Preserving your fertility can mean either taking steps to halt the amount of damage or harvesting the precious eggs for later use.
The options often are:
- Consider using a medicine called Lupron to “suppress your ovaries” to help them be resistant to the effects of chemotherapy.
- Consider moving the ovaries or shielding the uterus and ovaries to protect them from radiation.
- Harvest the ovaries and freeze them for re-transplantation in the future (this has only been shown to work in a few cases)
- Harvest the eggs for freezing. Thaw and fertilize them at a future time when you are cancer free.
- Harvest the eggs and fertilize them now as embryos. Then thaw them in the future for transfer into a healthy uterus.
None of the above procedures are guaranteed to work. Occasionally you may have insurance help or receive help from organizations like the Lance Armstrong Foundation to cover the cost of treatment. Most of the above procedures can be carried out within 2 weeks, allowing chemotherapy or radiation to proceed without delay.
Having trusted friends and wise counselors can help you navigate this tough time. At RSC, we also have a list of counselors who can help you through the process emotionally in combination with your nursing team.