Cancer treatment often leaves survivors unable to have children
Fertility preservation techniques can offer a glimmer of hope, Caitlin Dunne says.
Young people diagnosed with cancer usually have one goal: survival. But after the tribulations are behind them, cancer survivors want to live a full life. For many, this includes having children. Unfortunately, most young cancer patients are not aware of the devastating effect chemotherapy and radiation can have on their ability to reproduce.
According to the Canadian Cancer Society, 10 per cent of all new cancer diagnoses occur in people aged 20 to 49 years old. The most common (across both sexes) is breast cancer. The good news is that modern chemotherapeutic protocols are very effective at killing malignant cells. Curing cancer is becoming more common every year. In Canada, the net five-year survival rate for breast cancer is now 87 per cent.
The bad news is that chemotherapy for breast cancer will advance a woman’s reproductive age by 10 years. This massively diminishes the chance of having a baby. Infertility rates are often underestimated in young women after chemotherapy because, although some will resume having menstrual cycles, far fewer will actually be able to conceive.
Some studies suggest that the psychological impact of subsequent infertility is more traumatic than the cancer treatment itself.
A woman’s egg supply is finite. Chemotherapy and radiation destroy eggs — either by killing them directly, or by damaging the genetic material within the eggs so they cannot function.
Egg quality also declines naturally with age. And, it is standard to wait three to five years in remission before a doctor will advise that a woman can become pregnant. The passage of time combined with chemotherapyinduced egg damage make young women particularly vulnerable to infertility after cancer.
Men and boys are also at risk of losing their fertility to cancer treatment. Leukemia, lymphoma and testicular cancer are some of the most common malignancies in younger males. Each of these cancers is considered highly curable. Testicular cancer, for example, has a five-year survival rate of 96 per cent. But the surgery, chemotherapy and radiation required for cure often irreparably damage testicular stem cells. Depending on the dose of radiation or type of chemotherapy, 30 to 90 per cent of reproductive-aged males will be rendered sterile.
Fertility preservation gives young people with cancer the hope of having children in the future. For women, this means undergoing in vitro fertilization (IVF) to bank eggs (or embryos if they have a male partner to contribute sperm). Women must take hormone injections for 10 days to stimulate multiple eggs, followed by a short procedure to harvest the eggs. New flashfreezing technology employs liquid nitrogen to transform the eggs (or embryos) into a glasslike state for storage. They can safely remain frozen until the woman is healthy enough for pregnancy. Doing IVF before cancer treatment does not usually delay chemotherapy nor does it appear to worsen the prognosis.
Sperm banking is the principal means of fertility preservation for men and boys. Sperm counts are often low during illness, but even tiny numbers of sperm can be usable for IVF in the future.
There are two significant barriers to accessing fertility preservation in Canada: lack of awareness and cost.
Because of the focus on survival, oncologists often forget to discuss the damage cancer treatment will do to fertility. Research suggests that fewer than 10 per cent of reproductive-aged cancer patients are offered consultation with a fertility doctor.
The cost of an IVF cycle can range from $7,000 to $10,000. Quebec and Ontario have provincially funded programs for fertility-preservation services, but these do not pay for medications (which cost another $3,000-$5,000).
The rest of the provinces offer no financial help.
Fertile Future is a national charity run by fertility doctors. Their Power Of Hope program covers the majority of costs for fertility preservation at participating clinics across the country.
To date, Fertile Future has helped 549 people bank eggs, sperm and embryos. Caitlin Dunne is a fertility specialist and co-director at the Pacific Centre for Reproductive Medicine, which has locations in Edmonton and Vancouver. She is also a clinical assistant professor at the University of British Columbia.