Family Matters

First Comes Cancer, Then Come Children: The New World of Oncofertility

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Cancer used to be an old people’s disease. No longer: we all have friends and colleagues — young people, in their 20s, 30s, 40s — who’ve been on the receiving end of a scary diagnosis. The good news is that a verdict of cancer is no longer the death sentence it once was. Survival rates are on the rise, accompanied by a wave of survivors of child-bearing age who want to have children. But can they?

The answer often lies in whether they were offered fertility preservation techniques — the subject of a recent article I wrote in Time Magazine. Consider Lindsay Beck’s story, for example. Inspired by the frustration she experienced when trying to preserve her fertility before treating her tongue cancer, Beck, 34, founded Fertile Hope in 2001. Now part of Lance Armstrong’s LIVESTRONG Foundation, it’s dedicated to helping cancer survivors start families. (More on 5 Pregnancy Taboos Explained (or Debunked))

Only 24 when she learned treatment would leave her with a 90% chance of infertility, Beck was given zero guidance on how she might safeguard her fertility. Her reaction was immediate and visceral; she refused treatment. “Why fight so hard to live if you are going to rob me of all of my dreams?” she demanded. Soon enough, she reconsidered and decided to start chemotherapy, albeit with a plan: Men could freeze sperm, she knew; why couldn’t women freeze eggs? In the six weeks she had left before treatment began, Beck called scores of fertility clinics around the Bay Area, where she lives. None of them offered egg cryopreservation. Finally, she phoned Stanford, which had just launched an experimental egg-freezing program for cancer patients. Twelve days later, Stanford froze 29 of Beck’s eggs. Women commonly describe trips to the fertility clinic as harrowing; Beck loved them.  “They were my favorite doctor visits because I felt I was doing something active to survive,” she says. Now the mother of a 4-year-old daughter and a 2-year-old son born via IVF due to an unrelated genetic abnormality in her husband’s sperm, Beck continues to evangelize about the importance of raising awareness about fertility preservation. She’s witnessed significant advances since she was diagnosed a decade ago when, as she puts it, “essentially patients were being sterilized without their knowledge or permission.”

“It’s not perfect now,” says Beck, who helped write the guidelines issued by the American Society of Clinical Oncology in 2006 advising physicians to inform patients of their options, “but it is so much better.” (More on Photos: The Landscape of Cancer Treatment)

Because women’s reproductive tracts are far more complex than men’s, oncologists often are more hesitant to bring up the subject of fertility preservation with their female patients. “It gets passed over because it’s complicated to talk about,” says Leslie Schover, a clinical psychologist at MD Anderson Cancer Center who did much of the early research on fertility preservation. Slowly, attitudes are shifting. At the Northwestern-based Oncofertility Consortium, a group of some 60 cancer centers has pledged to consider future fertility hand-in-hand with plans for chemotherapy and radiation.

And in about a dozen hospitals across the country, including major ones at the University of California-San Diego and the University of North Carolina at Chapel Hill, cancer patients are now using a new touch-screen computer whose queries they answer in the waiting room. It covers a host of potential patient questions, including this one: Are you concerned about having children? “This is the first time that people are asking this as a standard part of cancer care,” says Matt Loscalzo, who helped develop the computer and directs the Department of Supportive Care Medicine at the City of Hope Hospital and National Medical Center outside Pasadena. “It really hit me between the eyes that we had to ask this question before cancer treatment,” says Loscalzo, who crafted it as a direct result of counseling infertile cancer survivors who hadn’t been offered fertility preservation. “If we waited until after, it was too late because they were often sterile.”

Cancer treatment comes with a host of unsavory side effects. Skirting death only to be denied the chance to give life seems particularly harsh, and, in this day and age, completely unnecessary.

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