Your Cancer Answers: Does cancer cause a fertility issue? – Lompoc Record

QUESTION: Does cancer cause a fertility issue?

It is hard enough to hear the words you have cancer," but to then be told that the treatment being recommended may cause infertility is almost unbearable for some patients. In recent years, improvement in treatment and survival expectations have increased the need for cancer patients to make informed decisions about addressing their risk of infertility following therapy.

The risk of infertility depends on the specific treatment the patient will receive. Certain chemotherapeutic agents carry a low risk of infertility, while others carry a high risk. Radiation can also cause infertility, but methods such as shielding and transposition -- using surgery to temporarily move the ovaries out of the intended radiation field -- are used to decrease this risk. Unless it alters the reproductive organs, cancer surgery generally has a low risk of infertility.

It is important to have the discussion about fertility preservation before treatment begins, usually at the time of diagnosis. Unfortunately, many patients are so overwhelmed by the diagnosis and the information given to them that they dont even consider fertility issues but the basis question still remains: Do you want to have children?

One of the most challenging issues we face is patients who need to start treatment rather urgently. When you tell patients you can preserve their fertility, but will have to hold off on treating their cancer for several weeks, some of them will get very nervous. Sometimes the patients cancer is very aggressive, and it is imperative to begin treatment as quickly as possible and fertility cannot be addressed. Some patients will come through their cancer treatment with normal fertility and others will have permanent infertility. If they have infertility, options are then discussed such as adoption, using a gestational carrier and using donor eggs or donor sperm.

For men, the approach to preserving fertility is relatively simple. The patients are referred to a sperm bank, where they provide a specimen that is subjected to semen analysis and infectious disease testing and then frozen and stored until they wish to have children. The longest time between banking sperm and using the specimen for successful in vitro fertilization is 25 years. If men are not able to easily produce viable sperm, testicular sperm extraction using fine needle aspiration may be an option.

For women, harvesting eggs remains a greater challenge, especially in cancer patients. The standard of care remains freezing the harvested eggs alone in addition to inseminating the harvested eggs and freezing the resultant embryos. Before any eggs can be harvested, the ovaries must first be stimulated with hormones to produce multiple eggs. This process takes two to three weeks, putting egg harvest and preservation beyond the reach of some patients who need to start therapy immediately.

The financial burden of preserving fertility after cancer treatment can be significant. For men who bank their sperm, the cost of the semen analysis, infectious disease testing and one year of storage is around $650. For women who elect to freeze embryos or eggs, the cost is much higher, on the order of $15,000 per in vitro fertilization cycle. Some patients insurance plans cover these costs, but these tend to be the exception, not the rule.

The American Medical Association recently adopted a resolution stating insurance should pay for fertility -- a treatment that causes infertility has resulted in a defect that has a huge implications for the patients qualify of life. Hopefully, it will be only a matter of time before fertility-sparing treatments for these patients are covered by insurance.

Some studies have shown that cancer-induced infertility can be as stressful as the cancer diagnosis itself, and the stress can persist many years after the patient has been cured. There can be a lot of regret in that, especially for people who had no idea that they might have had options to have their own biological children. We tell patients we are giving them drugs, radiation and surgery which might cause these problems, and it is our responsibility to offer solutions and make them available and acceptable for everyone.

For more information, call Liz Elliott, nurse navigator at Mission Hope Cancer Center, at 805-346-3405.

Dr. Monica Rocco is a board-certified general surgeon who has devoted her surgical practice to caring for patients with breast disease and providing diagnosis and care before, during and after surgery. She serves as a member of the Marian Regional Medical Centers specialized surgical staff and oversees the Mission Hope Breast Care Center. She is also the surgical director of Marian Cancer Care. Rocco can be reached at 346-3456.

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Your Cancer Answers: Does cancer cause a fertility issue? - Lompoc Record

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