Some of the most emotionally difficult conversations I have in my office on a weekly basis are those with patients who are diagnosed with cancer and come to me for fertility preservation. There is a psychological “double blow” hitting them all at once: not only is their cancer itself scary, but they are also worried that they will not be able to have children afterwards because chemotherapy and radiation – while life saving – can damage their sperm and eggs. Fertility preservation is a paramount concern for both men and women faced with cancer treatments. This is why it is important to tackle these difficult issues even in younger patients who are not planning to have children until the distant future. Cancer patients are understandably focused on their treatments, but fertility preservation should not be overlooked. Here are some common misconceptions and insights that often surprise patients and even some of my medical colleagues.
Many people believe that the time required for fertility preservation procedures will delay cancer treatments and decrease their success. I am happy to say that this is not true; fertility preservation can be done within a day for men and within two weeks for women. This is done in conjunction with a patient’s cancer schedule with the blessings of their oncologist.
Men and Fertility Preservation
Like infertility in general, men and women have equal need for fertility preservation. Chemotherapy and radiation can permanently damage a man’s ability to make sperm afterwards. Some men regain the ability to make sperm in the years following their cancer treatments, but many never do, so it is critical to freeze, or cryopreserve, their sperm samples prior to initiating any treatments. Our dedicated team will schedule men to produce and freeze samples very quickly, even on weekends, when timing is critical.
Women and Fertility Preservation
Oocytes, or eggs, are extremely sensitive to chemotherapy and radiation treatments. Making this problem even worse is that the women have a finite number of eggs that must last a reproductive lifetime. The major concern is that cancer treatments will severely damage this egg supply making fertility very difficult or impossible afterwards.
Women have three main options for fertility preservation. First, they can freeze their eggs ahead of time – termed oocyte cryopreservation. In this way women can preserve their fertility while also maintaining their reproductive autonomy if they are not in a committed relationship, because these eggs can be fertilized with any sperm source in the future. Second, they can freeze embryos after their eggs are fertilized with their partner. Third, we can give them strong hormonal suppression medications during chemotherapy to hopefully protect their egg supply from the chemotherapy. This option is not foolproof and falls under the “can’t hurt, probably helps” category, whereas egg and embryo freezing present a much stronger, more reliable form of fertility preservation.
Even patients who have already completed their cancer treatments before coming to see me can still build their family. Not all patients lose their fertility entirely and still can conceive with the help of fertility treatments. Additionally, even those whose fertility has been severely compromised or lost can still avail themselves of donor sperm, donor eggs and even gestational carriers. There are many ways for a person to build his or her family, and we are here to help our patients find the best one for them individually.
Fertility Treatments and Cancer Risk
A very important topic is whether fertility treatments increase the risk of cancers. I am happy to report that many studies over many years have found NO LINK between fertility treatments and female breast, uterine or ovarian cancers. Recently, a scientific paper was published that found no increased risk of breast cancer among women who had undergone IVF treatments. (“Ovarian Stimulation for In Vitro Fertilization and Long-term Risk of Breast Cancer,” Alexandra W. van den Belt-Dusebout, et al; Journal of American Medical Association, July 19, 2016). This study is one of the largest and most comprehensive studies to date on this topic and confirmed our earlier research that showed similar findings.
In summary, there are many excellent fertility preservation options for both men and women these days. They work very well, can fit into even the tightest cancer treatment timelines and give hope and future family-building options for all our patients.
Dr. Hurwitz is a board-certified reproductive endocrinologist and senior partner at Reproductive Medicine Associates of Connecticut (RMACT), which has offices in Stamford, Norwalk, Danbury and Trumbull. He also sees patients at an affiliate office in Poughkeepsie, NY. He has worked with hundreds of infertility patients and won numerous awards, including “Top Doctor” in New York magazine. In addition to his work with patients, he is also Division Director of Reproductive Endocrinology and Infertility (REI) services in the Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital. To learn more about Dr. Hurwitz and fertility preservation, please go to www.rmact.com.