While it may seem like the path to parenthood seems linear (perhaps you remember the nursery rhyme: “First comes love, then comes marriage, then comes the baby in the baby carriage.") this is far from reality. Everyone’s fertility journey is totally different. Sometimes you start out thinking you’re on one path, only to be confronted with what might be an unanticipated or unwanted new reality. For some, this comes in the form of a breakup or a declining rate of fertility but for others, fertility considerations are brought forth by the need for chemotherapy.
In fact, anywhere from 20% - 70% of people who undergo cancer treatment will be left infertile by chemotherapy or radiation treatment. Prior to undergoing what is technically referred to as gonadotoxic radiation and chemotherapy, female patients have the option to freeze eggs or embryos. While it’s not guaranteed that a cancer patient will become completely infertile, egg freezing offers a chance to keep some eggs in case she might want to use them in the future.
It may come as no surprise that a cancer diagnosis compounded with an array of questions around future fertility can be incredibly anxiety-inducing. Research has shown that between 30% - 50% of patients decide not to freeze and some of them regret not freezing after chemotherapy when it’s already too late. This sense of regret is alleviated when the patient is counseled about their options both by an oncologist and a fertility specialist - however, there is some conjecture that this doesn’t often happen.
According to the American Cancer Society: “It's best that discussions about preserving fertility take place before cancer surgery happens or before treatments begin. Don't assume your doctor or nurse will ask you if fertility is important to you. They don’t always remember to bring this up, so you might have to bring it up yourself.”
In lieu of proper counseling, cancer patients are often left with no other choice but to create their own journey to figure out what’s right for them. One of these patients is Min. We interviewed her to get her experience after being diagnosed with uterine cancer.
How did you begin your fertility journey?
I started my fertility journey haphazardly. I was diagnosed with uterine cancer. As a healthy and active (albeit a bit overworked) woman in her thirties, receiving a cancer diagnosis was a complete shock.
Once the cancer had been identified, the planning for cancer treatment occurred at a fairly rapid pace. I feel fortunate that my doctor was upfront with me about how cancer treatment could negatively impact my fertility. The doctor told me that if the cancer were to progress (which it did), then the necessary surgical procedure would mean I would no longer be able to have children. If I wanted to preserve my fertility, the maximum period to become pregnant would be 1+ years before the treatments have to commence.
Since I did not have a partner at the time, I decided to explore fertility preservation options (egg freezing) in the EU, which is where I was living at the time.
How did you explore fertility preservation options after your cancer diagnosis?
The first place I went was an oncology-gynecology clinic, which mostly offered advice and consultation about uterine/ovarian cancer treatments. I found that because the main focus of the clinic was oncology, they offered limited advice on fertility preservation techniques and options. In fact, they suggested that I seek out fertility preservation/egg freezing clinics mostly on my own.
I did some research online and setup a few calls with private clinics mostly based in Germany as well as one in Prague. I found the clinics to be professionally curated and staffed with experienced employees, complete with a fertility counsellor (i.e. sales/customer support). Egg freezing treatment was relatively affordable (5K EUR) by international standards. I also received recommendations for fertility clinics in Spain given their reputation for high quality fertility care. However, because I was a cancer patient, the private clinics that I contacted were reticent to continue with egg freezing without close medical guidance from my oncology team.
SIDEBAR ON FERTILITY PRESERVATION IN THE EU
Although assisted reproduction is now legislated in almost all European countries, substantial variations based on sexual orientation and marriage status exist for reproductive services by countries. For instance, non-medical ("social") egg freezing is not permitted in Austria, France, Hungary, Lithuania, Malta, Norway, Serbia and Slovenia, but is allowed in Germany and Switzerland.
What are some challenges you encountered throughout the fertility process?
I found it really hard to sift through the options and seemingly endless education materials. Of course, this all had to happen in tandem with the emotional rollercoaster of a cancer diagnosis, my own self-reflection on family planning as well as an immediate need to salvage my fertility during a very limited time frame.
However, once I overcame the initial hurdle of fertility preservation education, I started to feel a sense of agency and control that I know will enable me to face other cancer treatments down the road.
What advice would you give someone with a cancer diagnosis who is considering fertility preservation?
Do your research, consult your doctors, and talk to others who have gone through it. There are a number of non-profit sites for cancer patients that want to know their fertility preservation options and there is a specific section about it in the book Everything Egg Freezing. But the fact still remains that it’s relatively unusual for younger women to be diagnosed with cancer and as such, there aren't as many resources that you might find as you would for elective egg freezing.
Needless to say, the starting point should always be from your medical treatment team. Ask for recommendations to clinics from your doctor, get in cancer care groups to talk to others, and educate yourself on the cost/options/risks.
Last but not least, make sure you have given yourself ample time to think through the options. Yes, there is time pressure to make decisions given the treatment cycles, but you want to take the time you need to make such a personal decision.