Support for Young Adults with Cancer
Family Planning & Fertility Options
Thinking – and talking about – your fertility is an unexpected necessity that comes with having cancer at this age. Whether having children is part of your life plan or something that isn’t even on your radar yet, you should understand how various treatments can affect your ability to have biological child. As you make a treatment plan with your medical team, talk through your vision for having a child or adding to your family and what fertility preservation options may be available to you.
Cancer centers that specialize in young adult cancers may have a multidisciplinary team that focuses on oncofertility, a medical field that connects oncology with reproductive health. This team of specialists can help you understand how your fertility may be affected and the options you have.
An oncofertility team is typically made up of the following specialists. If your cancer center does not have a dedicated oncofertility team, be your own advocate. Ask your nurse navigator or case manager for referrals:
- Your oncology care team
- Nurse navigator
- Case manager
- Endocrinologist
- Fertility/reproductive specialist
- Genetics counselor
- Urogynecologist (gynecologist and/or a urologist)
- Family planning specialist
- Adoption professional
- Social worker/mental health professional
Fertility Protection and Preservation
Cancer and its treatments can damage the organs and tissues in the reproductive system. For females, the reproductive system includes the vagina, cervix, uterus, ovaries and fallopian tubes; for males, it includes the penis, testes and prostate.
The risk for damage depends on the type of treatment and the area being treated. The damage is not always permanent; sometimes it is temporary. Treatments that typically affect fertility are chemotherapy, high-dose or targeted radiation to the pelvic area, and surgery that removes reproductive organs or tissue.
In some cases, reproductive organs can be protected from damage during treatment. For example, during surgery for early-stage ovarian cancer, the surgeon can remove the cancerous tissue and leave the healthy ovary in place. During radiation therapy for other cancers, a special shield made of lead can protect the ovaries or testicles from the damaging effects of radiation (known as gonadal shielding). In an oophoropexy, the surgeon attaches one or both healthy ovaries to the abdominal wall to keep them out of the field of radiation.
Preservation techniques include:
- Egg freezing. Eggs are removed from the ovaries and frozen.
- Embryo freezing. Eggs are removed from the ovaries and fertilized in a lab to create an embryo. The embryo is then frozen.
- Ovarian tissue freezing. The ovary or part of it is removed, frozen and put back after cancer treatment.
- Sperm banking. Semen is collected and frozen. Sperm banking can happen at a urologist’s office, or kits can be ordered online.
- Testicular sperm extraction. Sperm cells are removed directly from the testicle and frozen.
- Testicular tissue freezing. A small portion of tissue from the testicle is removed, frozen and used to try to make sperm from it later.
Timing
Ideally, you should discuss fertility preservation before you and your team decide on a treatment plan because some fertility solutions can take days or even weeks to get underway. However, that may not be possible if beginning treatment right away could be lifesaving. That doesn’t mean, however, that becoming a parent is out of the question. Learn about your options and discuss them with your loved ones and others whose advice you trust.
Preventing pregnancy during and typically after treatment for a certain amount of time is important because cancer treatments can lead to serious birth defects. This applies to females and males. Talk with your oncofertility team about the most effective types of birth control to use. They may be
different than what you’ve used in the past. For example, if your cancer is hormone-driven, you may have to avoid hormone-based birth control, such as a birth control pill. Let your oncofertility team know right away if you are pregnant or suspect you are pregnant during treatment.
After treatment ends, you may still have family planning options. These include using donor eggs or embryos, surrogacy or gestational carrier (having another woman carry your baby), adoption, natural conception and assisted reproductive technologies (fertility treatments).
Questions to ask NOW
Learn as much as you can about your options, then give yourself time to really think about what you want for your future.
Ask your medical team:
- What is my risk of infertility based on my diagnosis and the suggested treatment options? What fertility protection or preservation options are available to me?
- Will one type of treatment be safer in terms of preserving my fertility? Will that “safer” option jeopardize my health?
- Is there a risk for carrying a pregnancy full term after treatment ends?
- I’m currently pregnant. How will this affect my treatment?
- What is the cost of fertility preservation? Will my insurance cover any of it?
Ask yourself:
- Is having children important to me?
- How do I feel about freezing eggs, sperm or embryos?
- Is using donor sperm or a surrogate an option?
- Am I open to adoption or fostering?
- I am already a parent. Is having more children important to me?
