Guest column | At 23, I faced infertility from chemo. I refused to freeze my eggs.

Infertility is often a silent companion to cancer treatment, affecting many young patients in ways they may not even realize. The journey of a young breast cancer patient, who recently faced infertility due to chemotherapy, serves as a poignant reminder of the importance of fertility preservation.

The Hidden Impact of Cancer Treatment

Cancer treatment is a lifesaving endeavor, but it also comes with a hidden cost – the potential to damage fertility. Chemotherapy, in particular, can be toxic to the ovaries, leading to a loss of primordial follicle reserve and premature ovarian failure. This means that even young women, who may have their whole reproductive lives ahead of them, can find themselves struggling with infertility after treatment.

A Young Patient's Story

As a young breast-cancer patient, she thought undergoing fertility treatments sounded horrendous. And she never planned to have biological kids anyway. But the harsh reality of chemotherapy's effects on fertility soon became apparent. For many patients, the decision to preserve fertility is not just about having children; it's about maintaining a sense of hope and control during a daunting time.

The Importance of Fertility Preservation

Fertility preservation is a crucial aspect of comprehensive cancer care, yet it remains a frequently overlooked consideration. The American Society of Clinical Oncology (ASCO) has emphasized the importance of addressing fertility concerns early on, recommending that oncologists discuss fertility preservation options with patients before initiating treatment. However, despite these guidelines, many young women with cancer remain uninformed about the potential for cancer-related infertility.

The Process of Fertility Preservation

For those who decide to pursue fertility preservation, the options can be both complex and time-sensitive. Women can opt for egg retrieval and freezing, which typically involves stimulating the ovaries to produce multiple eggs, followed by a procedure to extract and cryopreserve them. This process can often be accomplished without significant delay in cancer care, especially if patients are referred early in their treatment planning.

Men also have fertility preservation options, including sperm freezing. For girls who have cancer treatment before puberty, ovarian tissue cryopreservation is an option. This involves surgically removing and freezing ovarian tissue, which can later be thawed and reimplanted. These procedures are critical for maintaining hope and providing a future possibility of motherhood or fatherhood.

Challenges in Fertility Preservation

Despite the importance of fertility preservation, several barriers exist that hinder patients' ability to make informed decisions. These challenges include limited time for making decisions, lack of awareness, and significant financial costs. Many patients feel that they do not have the time to consider fertility decisions or collect necessary information, such as insurance paperwork and fertility status.

The Emotional Toll

Infertility can have a profound emotional impact on young women with cancer. It can lead to distress, regret, and even depression, especially if patients feel that their fertility concerns are not adequately addressed by their oncology care teams. A recent study highlighted that a substantial proportion of young female patients with breast cancer report concerns about fertility, emphasizing the need for early discussion and intervention.

A Future Without Biological Children

For those who choose not to pursue fertility preservation, the decision is often driven by personal circumstances and the overwhelming nature of cancer treatment. Some young women may not see themselves having biological children in the future, or the process of fertility preservation might seem daunting. However, it's essential to acknowledge that this choice affects not just the individual but also their loved ones, who may have envisioned starting a family together.

The Role of Medical Teams

Medical teams play a crucial role in ensuring that young women with cancer are informed about their fertility options. Clinicians should address the possibility of infertility and discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. This proactive approach can significantly reduce long-term regret and distress among survivors.

Support and Resources

While the journey to fertility preservation can be complex, there are resources available to support patients. Many hospitals offer comprehensive fertility preservation services, including patient navigators who guide patients through the process. Online resources and support groups also provide valuable information and emotional support, helping patients navigate the decision-making process.

Conclusion

Cancer treatment is a path fraught with uncertainty, and fertility preservation is an often-overlooked aspect of this journey. By discussing fertility preservation options early on, medical teams can empower young women with cancer, ensuring that they have a choice in their future reproductive health. It's time to break the silence surrounding cancer and infertility, acknowledging the unspoken truth that these two conditions often intersect.

References:

• Duke Health
• PMID: PMC8218210
• Mayo Clinic
• ASCO Publication
• JAMA Network