A cancer diagnosis can disrupt many life plans, including how and when patients can start a family. Some treatments can delay the timeline to safely become pregnant, or they can temporarily or permanently affect fertility.
The experts at UW Health Fertility Care work collaboratively with UW Health | Carbone Cancer Center providers to help educate patients about fertility options before starting cancer treatments, including affects on fertility, available assistance freezing sperm or eggs, or creating and preserving embryos if they choose. These conversations are especially critical with the trend of more younger patients being diagnosed with cancer.
“What’s hard about cancer is the lack of control. A lot of patients feel like cancer is taking something from them,” said Dr. Laura Cooney, a reproductive endocrinology and infertility specialist with UW Health Fertility Care. “Our ability to do fertility preservation is hopefully preventing cancer from taking another thing from them and increasing the chances they can have a family in the future.”
When should you discuss fertility?
Cancer patients of reproductive age can reach out to UW Health Fertility Care for a consultation to understand the fertility impacts of treatment, both short-term as well as what could be prolonged or permanent.
Ideally, patients are referred to the clinic before starting treatments, Cooney said.
“Even if the oncologists haven’t decided what treatment is going to happen yet, they will often refer patients to us for a discussion,” she said. “With most situations, we’re trying to (complete fertility preservation) before starting chemotherapy.
That’s because certain types of chemotherapy and radiation around sexual organs can impact the number and quality of eggs and sperm. Some patients may also need to take medications to reduce or block the production of sex hormones for several years to prevent their cancer from returning. Some patients may also have to have their ovaries, uterus or testicles removed.
What services are available?
UW Health Fertility Care can help cancer patients review the risks of their specific diagnosis and treatment plans to their future fertility. For some patients, there is only a temporary impact on ability to conceive.
“Just because someone received chemotherapy does not mean that they are infertile, and it’s really important that patients know that,” Cooney said.
Freezing sperm is a relatively quick process that has a minimal impact on when patients can start cancer treatments. Egg retrieval takes longer, as patients will need to take fertility medications for about two to three weeks to encourage egg growth. This delay can cause anxiety in patients eager to start cancer treatments.
“With a lot of these solid tumor cancers, like breast cancer, colon cancer, ovarian cancer, we have a lot of really good data that delaying chemotherapy for about two to three weeks (to pursue fertility preservation) does not impact the success of cancer treatments,” Cooney said.
UW Health Fertility Care providers work collaboratively with patients’ cancer care teams to discuss fertility medications that are being given and coordinate timing of when those fertility interventions are complete so patients can quickly resume cancer treatments.
“This is absolutely a multidisciplinary conversation,” Cooney said. “We are in sometimes daily contact with their oncology team. We’re giving estimates on how quickly someone’s cycle is going and their oncologist is scheduling the start of chemotherapy from that.”
For blood and lymphatic cancers, treatment timing is more urgent, so fertility preservation is not always possible. Still, Cooney said, those patients can benefit from meeting with the UW Health Fertility Care team.
“It’s still really good for us to have that conversation with patients, because some chemotherapies are less damaging (to egg and sperm development) than others, and it can be reassuring for patients to know that they still could have a very good chance of good fertility in the future even if they don’t have time to freeze eggs or sperm,” Cooney said.
Addressing challenges
UW Health Fertility Clinic has two health psychologists that provide support to patients as they navigate options. They also help patients prepare for challenging scenarios, such as the potential their fertility preservation efforts are not successful.
“These are big, challenging pieces that our health psychologists are supporting patients with,” Cooney said.
Patients who have a genetic mutation that puts them at higher risk of certain cancers are often concerned about passing that on to children.
“There are ways for us to screen for those mutations to help decrease the chances their child would have them,” Cooney said.
Financial hardship may also deter patients from considering fertility preservation, but Cooney encourages patients to have an initial discussion with the clinic. Discounted services are available for cancer patients seeking fertility preservation.
“It can be empowering for patients just to discuss what their particular risk is with their diagnosis, what chemo they’re taking, their age, and personalize their options,” she said.