FUTURE DREAMS
A cancer diagnosis need not end hopes for a family
NEEDLESS to say, there’s a dizzying array of questions to consider when you’re given a cancer diagnosis. Coming up with a game plan to preserve your fertility can be one of the biggest stressors. Thankfully, modern medicine has made the hope of becoming a mom or pop postcancer attainable.
OB-GYN Dr. Jovana Lekovich is on the front line. As a reproductive endocrinologist and infertility specialist at Reproductive Medicine Associates of New York (RMA NY) and director of the oncofertility program at the Blavatnik Family — Chelsea Medical Center at Mount Sinai, she’s there to help patients forge a path forward.
“Facing a cancer diagnosis as a young person is devastating,” said Lekovich. “Patients often feel additionally overwhelmed to learn that treatment might prevent them from ever having biological children. What I always like to point out is that the very fact that they are being referred to me to discuss fertility preservation is an incredibly positive thing. It signifies that their oncologist and I are confident they will survive this and that it will soon be in the rearview mirror.”
To that point, it’s best to seek out a reproductive endocrinologist who specializes in oncofertility, a subfield that deals exclusively in family planning for cancer patients and survivors.
For the most part, cancer doesn’t necessarily have a detrimental effect on fertility. Rather, it’s the cancer treatment — including chemotherapy, surgery and radiation — that can damage a patient’s reproductive future.
Specifically, chemotherapy can impact reproductive tissue and lead to infertility. Radiation can decrease “egg and sperm quantity and quality [and] also reduce uterine size leading to an inability to carry a pregnancy,” said Dr. Jaime Knopman, director of fertility preservation at CCRM Fertility New York. Hormone therapy can change estrogen, progesterone and testosterone levels which can hinder production and maintenance of eggs and sperm. Additionally, surgery may remove reproductive organs. Radiation to the pelvis will cause premature ovarian failure and induce menopause (among other side effects).
Dr. Akila Viswanathan of Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and interim director and professor of radiation oncology and molecular radiation sciences who treats young women with locally advanced cervical cancer, noted that “radiation causes changes to all gynecologic organs which makes it not possible to carry a pregnancy to full term, and ovarian dysfunction.”
For male patients, the directive is pretty straightforward: Bank your sperm (semen cryopreservation) before chemotherapy or radiation. There are limited options for prepubescent boys since they don’t have mature sperm cells. In this case, “testicular tissue cryopreservation can be done, but there are no live births through this procedure yet, and is considered highly experimental,” said Lekovich.
For women with a new cancer diagnosis, as long as they’re clinically stable and have a reasonable prognosis, fertility preservation should be strongly considered before treatment begins.
“Women may elect to freeze their oocytes [egg cells] as it is quicker and cheaper than an in vitro fertilization [IVF] cycle,” said Dr. Janelle Luk, co-founder and medical director of Generation Next Fertility. (An IVF cycle involves combining the eggs with sperm to make an embryo.) However, an egg-freezing cycle typically takes around two to three weeks, and “all options for women do require some form of hormone therapy, invasive procedures and time,” said Luk.
Other options include the freezing of ovarian tissue, hormonal medications, and experimental approaches such as uterine transplants. “You often have just one shot at it before the cancer treatment starts, and there is not that much room for error and experimentation,” said Lekovich.
On the financial front, while New York state has a law in place that obliges insurance companies to cover three cycles of IVF treatments, you may still be responsible for some co-insurance or deductible. Some options to explore include Generation Next Fertility’s “Eggtober,” which runs this October in recognition of breast cancer awareness month. They are offering a free egg-freezing cycle for women currently or previously diagnosed with breast cancer. There’s also Chick Mission, a nonprofit which advocates for patients and gives monetary need-based grants.
For Lily Weinbach, opting for fertility preservation has been a veritable boon. Now a sophomore at the University of Michigan, Weinbach froze her eggs after being diagnosed with colon cancer at 18.
“I had surgery that would remove my entire colon and six months of chemotherapy. I decided it would be the smartest decision for me to freeze my eggs, as an insurance policy,” she said. “I still hope to be able to conceive naturally, but this makes me feel a whole lot better. They ended up getting a good number of viable eggs. Now, I’m 20 and currently being treated for a relapse in my liver. I now can go forward with treatments that otherwise would’ve changed my future in a huge way, but knowing that I have the option to use my own eggs no matter what.”