Can­cer treat­ment of­ten leaves sur­vivors un­able to have chil­dren

Fer­til­ity preser­va­tion tech­niques can of­fer a glim­mer of hope, Caitlin Dunne says.

Edmonton Journal - - EDITORIAL -

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.

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