By Alanna Kennedy
Focus on Fertility
Ongoing research aims to expand options for preserving fertility before and after cancer treatment
By Alanna Kennedy
For men who want to have biological children after cancer treatment, fertility preservation is a slightly different game. Unlike the procedures available to women, sperm banking requires no hormonal therapies and can be done quickly and easily. A man interested in banking his sperm can manually stimulate himself in order to expel seminal fluid for long-term storage.
Yet not all men of childbearing age are informed about the option when they are diagnosed with cancer. When Tom Whiteside learned he had lymphoma at age 26, his oncologist briefly mentioned to him that treatment could damage his fertility but didn’t suggest what Whiteside could do about it.
“I was the one who first brought [sperm banking] up,” says Whiteside, who lives in Austin, Texas, where he helps plan events for LiveStrong. “The doctor didn’t even know where I should go in the town I was getting treatment in.” Whiteside eventually found a fertility clinic near his oncologist’s office and was able to bank his sperm. Cancer patients like Whiteside who need help finding a sperm bank can turn to programs like Fertile Hope (www.fertilehope.org), part of LiveStrong’s SurvivorCare program, to locate a clinic in their area.
OPTIONS AFTER TREATMENT
Men and women who have already finished treatment without undergoing fertility preservation procedures aren’t necessarily excluded from having biological children.
There aren’t special fertility treatments specifically designed for female cancer survivors, says Clarisa Gracia, a reproductive endocrinologist at the University of Pennsylvania in Philadelphia. But there are options—essentially the same ones available to any woman struggling with her fertility, she explains.
“We’d treat them basically like other infertility patients,” says Gracia, “potentially doing in vitro fertilization, insemination or egg donation, or giving fertility medications to increase the number of eggs a month, which may increase the odds of getting pregnant.”
Gracia cautions that female survivors should wait a year or two before trying to conceive to lower the odds that they have a cancer recurrence while pregnant. But survivors who are at high risk of infertility shouldn’t wait much longer than that because chemotherapy often drastically depletes a woman’s egg supply. If these women aren’t yet ready to have children but would like to do so in the future, they should consider freezing embryos or eggs soon after treatment, says Levine. The procedures are the same as those available to cancer patients who have not yet undergone treatment (see “Options Before Treatment,” on the previous page).
Female survivors who have been trying unsuccessfully to get pregnant for three to six months shouldn’t delay meeting with a fertility specialist. The bottom line, according to Gracia, is that women should see an obstetrician who specializes in high-risk pregnancies and a fertility endocrinologist if they are having trouble conceiving, to help maximize the likelihood of conception.
There’s also hope for men who have already completed cancer treatment. According to Levine, even men who have very low sperm production may be able to father a child. One option is for the man to collect his sperm for artificial insemination of his partner. Or, if the man has an extremely low sperm count, his doctor can extract sperm using a testicular biopsy. The doctor then places a single sperm inside an egg to create an embryo that can be implanted in the man’s partner.
Ultimately, a cancer survivor’s best hope to have a baby is to consult a doctor about being proactive in addressing fertility—especially before cancer treatment begins. However, Marla Clayman, a health communication researcher at the Feinberg School of Medicine in Chicago, cautions that survivors should keep in mind that fertility procedures aren’t always successful. Fertility is never guaranteed, and even people who have never had cancer aren’t always able to conceive a biological child.