If you are at risk for infertility from your cancer treatment, it is important to think about two sets of issues
I. the significance of parenting to you
Questions you may want to ask yourself include:
- Have I always wanted children?
- How many children do I want to have?
- Does it matter to me if my children are biologically related to me?
- Would I prefer adoption to other parenthood options?
- Am I open to using donor sperm or donor embryos?
- How does my partner/spouse feel about all of these issues?
- Do I have ethical or religious concerns about assisted reproductive technologies? (Source: University of Iowa)
If you think you may want to pursue fertility preservation, start with a discussion with your oncologist.
II. The risks, benefits and cost of fertility preservation
- What is the success rate for different methods?
- How safe is ovarian stimulation in estrogen sensitive cancers?
- Is the delay in cancer treatment (average 3 weeks) acceptable to your oncologist?
- If no current male partner would you freeze eggs or embryos (using donor sperm)?
- What are the risks of pregnancy after cancer treatment? (if not using a gestational carrier)
- What are the costs of the method used and are their support groups / insurance coverage to offset cost?
These issues are better discussed with a fertility preservation specialist together with your oncologist
Listen to your physicians, ask for educational material then take few days to think about it. Read more and discuss your options with family and loved ones. There is no need to make an immediate decision.
This is a crucial health care provider for you if you were diagnosed with cancer. He will order necessary tests and will establish a plan for treatment including referring you for surgery or radiation treatment if needed and administer chemotherapy. Multiple surveys indicated that significant proportion of oncologists do not discuss fertility issues with young cancer patients. A comprehensive survey of 613 oncologists practicing in the US regarding knowledge, practice behavior and attitudes concerning preservation of fertility in cancer patients indicatedQuinn et al., 2009
- Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist.
- Referrals were more likely among female physicians.
- Referrals were more likely when patients routinely ask about preservation of fertility.
It has been my experience from talking to patients and colleagues that
- A well informed patient asking her oncologist the right questions is the strongest indicator that she will be referred for discussions of fertility issues and
- Fertility preservation specialists are more able to explain the possible effects of cancer treatment on future function of the ovaries, methods for preservation of fertility and potential for future conception.
Call to action; talk to your oncologist about fertility concerns before the start of treatment. If he does not answer your questions, find somebody who will.
Providing the … cancer treatment summary and survivorship care plan is being recognized as a key component of coordination of care that will foster the delivery of high-quality cancer care.
…Patricia Ganz, MD, UCLA