Cancer and Fertility — What Aren’t They Telling You?

When you’re diagnosed with cancer, fear of death can overwhelm any other issues. Which is too bad, because cancer treatment can — but doesn’t have to — take away your ability to have children. There are ways to preserve fertility, but providers too often don’t inform patients of their options.

A study in the journal Cancer showed that young women particularly don’t get enough information, before their treatment begins, to enhance their chances of conceiving.

Depending on the kind of cancer, how advanced it is and the medical profile of the patient, a range of treatments might be advised. Sometimes, decisions about them must be made quickly for the best chance at a positive outcome. Sometimes there simply isn’t time to preserve fertility, but when there is, often discussions are given short shrift when the doctor’s focused on discussing what’s involved in chemotherapy, radiation or both.

The researchers surveyed 459 teenage and young adult cancer patients across the U.S. They asked about what kinds of counseling was offered and what strategies were explained in terms of possibly preserving the patients’ ability to have children after their cancer treatments were completed.

About 7 in 10 subjects said they had learned that cancer treatment could make them infertile, but only about 3 in 10 males and nearly 7 in 10 females said the information included fertility-preserving options.

“It’s a brave new world, fertility preservation,” Dr. Nicole Noyes told CBS News. She’s a reproductive endocrinologist and director of the fertility program at the Langone Fertility Center in New York. “We’ve got to get the word out to more oncologists.”

As CBS noted, when an adolescent or young adult is diagnosed with cancer, treatment often follows immediately, sometimes within 24 hours if they’re diagnosed during an emergency room visit when they’re already quite ill. That tiny window isn’t really open to fertility-preserving measures, but young cancer patients otherwise have the advantage of a generous biological clock: Young men generally have robust sperm and young women have a large reserve of eggs in their ovaries.

If their treatment doesn’t include radiation to the pelvis or abdomen, or the strongest regimens of chemotherapy, they might not need fertility-preserving intervention. But just because younger women continue to menstruate doesn’t mean they’re fertile.

And preserving fertility is more challenging for women – younger, post-pubescent males with mature sperm can provide samples any time. It’s also not too expensive to freeze sperm.

But women are more complicated and have more choices to consider. Preserving their fertility might require an invasive medical intervention to harvest eggs when they’re already sick. These procedures can delay their treatment for cancer.

Freezing unfertilized eggs is a common option for preserving fertility, and success rates have improved over the years. If a woman has a partner, she might consider freezing a fertilized embryo. These measures are expensive.

CBS reported that some less fraught experimental procedures are showing promise, such as repositioning the ovaries during lower-level radiation, and removing some ovarian tissue for later transplant back into the patient. Hormone blocking drugs can stop the ovaries from producing mature eggs during cancer treatment, protecting them from some harmful exposure.

Because some of these advances for young women are considered experimental, insurance often won’t pay for them unless there’s a medical reason to do so, and Medicaid never covers fertility treatments at all. The case for covering them is more persuasive if fertility and cancer care are coordinated.

Noyes told CBS that if oncology and fertility specialists work together, more women are likely to receive these treatments as part of their overall medical care. Oncologists, she said, aren’t “following my literature; I’m not following what new chemos are there to treat things. Until somebody says, ‘Hey, you know they’ve made a lot of strides in this egg freezing,’ and they start sending patients, then they see.”

Dr. Margarett Shnorhavorian, the study’s lead author, agreed. She said the two medical specialties should “develop strategies that increase awareness of fertility preservation options and decrease delays in cancer therapy as fertility preservation for adolescent and young adult cancer patients improves.”

Until the medical professionals get their acts together, young cancer patients and their families should be aggressive in finding out the impact of their treatment on their fertility. No one relishes the prospect of discussing procreation in such intimate detail, especially if the patient is barely old enough to perform the act usually responsible for it, but because treating the so often is successful, it would be remiss no to think about a future beyond cancer, even if the doctors don’t.

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