Cancer & Infertility: The Good Part of the Bad News

We've known for a long time now that cancer treatment can save lives but also render survivors infertile, even completely sterile. Young people who were surviving cancer more often found their new lives had a huge gap: little to no chance of being a parent in the future.

Spurred by organizations like Fertile Hope and the Young Survivors Coalition, researchers began focusing on fertility preservation techniques and their usefulness for this population. We've come a long way with what we can offer both men and women who want a chance at family-building after they're cancer-free. (At Houston Fertility Center, we offer a number of these techniques and even have a site devoted just to deferring conception by way of preserving fertility.)

Now, it appears as though the numbers of women with infertility resulting from cancer treatment is bigger than we thought. A large survey study by the University of California, San Francisco (UCSF) has concluded that our previous understanding may have given women "unrealistically low assessments of their risks" for infertility.

Some of the salient points of this study:

*Acute ovarian failure (no longer having a menstrual period after chemotherapy) increases significantly with age at cancer diagnosis.

*For women who did not experience loss of menses, incidence of infertility increased significantly with age.

*The younger the woman was when diagnosed with cancer, the higher her chances of early menopause.

Learning that the impact of chemotherapy on fertility is greater than we assumed -- that's the bad news.

The good news? That we now have that knowledge and can let women and their oncologists know that the need for fertility preservation is more prevalent than we used to think.

Tis the Season For Donor Eggs: Fresh or Frozen Work

In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.

Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.

Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.

I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.

Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.

Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."

Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.

Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.


Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.

Fertility Treatment for Cancer Patients Is Reality. Even If They Don't Know It Yet.

Houston is a major destination for people battling cancer. The city's medical center is renowned for providing the most advanced cancer care available, and patients come from around the world to access life-saving science and techniques. Besides the facilities in the centrally-located Texas Medical Center, there are also cancer treatment centers in outlying areas around Harris County where patients are receiving the benefits of cutting edge research put into clinical practice.

More cancer patients are surviving and going on to live healthy, happy lives. But many forms of cancer treatment result in infertility. Fortunately, the technology exists now to take steps to preserving a person's fertility for the future. Freezing embryos and freezing eggs top the list of techniques proving successful. And for patients who have types of cancer that are transmitted genetically, the technology is available to screen embryos for the related genes.

I've networked for several years now with organizations that assist cancer patients, groups like Livestrong's Fertile Hope program, the Young Survivors Coalition, and the Susan G. Koman Foundation. Speaking to groups about fertility preservation is always eye-opening for them and for me. I continue to hear the same sense of surprise and sometimes regret from participants who wish they had known before undergoing cancer treatment. I wish they had known, too.

If you know someone who's struggling with cancer, let them know that infertility doesn't have to be part of the result. Help me and other reproductive endocrinologists make fertility treatment available to cancer patients, by spreading the word about the hopeful possibilities.

Also see:

Women Want Working Options for Motherhood
On Lindsay Nohr Beck's presentation at ASRM 2009.


Fertility Preservation and Oncology
My thoughts about Jane Brody's column on how oncology is still behind the curve in addressing their patients' future fertility needs.

When It Comes to Cancer, We're All On the Same Team

Did you know that many women who survive cancer are unable to have children later? That's because life-saving cancer treatments can result in complete sterility. Fortunately, cancer survivors are increasingly speaking out about what they want out of life after illness. I've been privileged to offer these women fertility-sparing options so they can choose life both ways.

This Saturday, October 2nd, one of my sons is running in the 2010 Komen Houston Race for the Cure. A couple of years ago, I spoke to a gathering of women who form the Education Committee of the Susan G. Komen for the Cure Houston, the nation's premiere advocacy and research organization. The questions from this particularly well-informed audience led me to realize that more general public education is needed.

Cancer survival increases steadily. Fertility treatments to allow survivors to become parents is available. What is still slowly developing is a pipeline of patient information and referral. Too many women find themselves on the infertile side of cancer treatment asking why they hadn't heard of fertility preservation before it was too late.

The Komen Foundation has funded great strides in research to help women survive cancer and go on to have fulfilled lives. I urge you to do what you can to continue supporting their mission. And spread the word yourself to friends affected by cancer: fertility preservation is not experimental science. It is medical care that is currently available.

Another Step Forward Toward Fertility Preservation

A drug used to treat ovarian cancer (cisplatin) promotes egg cell death by way of a particular enzyme. The good news: a drug used to treat a different (but related) disease, chronic myeloid leukemia (CML), protects egg cells from cisplatin's killing effects.

Researchers in Italy have published their interesting conclusions in the online edition of Nature Medicine (see a HealthDay News report on the Medline website.)

So far, these are initial studies performed with mice, but the call by cancer patient advocates for such research is loud enough that follow-ups shouldn't be far behind.

TV Reflecting Hopeful New Reality

Especially after hearing from my staff (who atttended the annual Young Survivors Conference in Dallas last month ) about the mix of hope and anguish that young women with cancer express about their future motherhood, it was reassuring to see the very popular TV show, Grey's Anatomy, work the forethought of fertility preservation into a current, compelling storyline.

A young woman must undergo intense and immediate treatments for invasive cancer. Her colleagues and friends think ahead for her and automatically include the OB team in her treatment plan.

In this related scene, the cancer patient's boyfriend reveals the understandable and expected emotions involved as people struggle to muster hope amid fears:

Men, Infertility, & Cancer

A large study published in February's Archives of Internal Medicine links testicular cancer to men who are seeking fertility treatment.

The researchers analyzed data from over 22,500 men in couples who sought fertility treatment between 1967 and 1998. After comparing against cancer registry data, the study authors concluded that the men were 1.3 times more likely to develop testicular cancer, and that those with male factor infertility were 2.8 times more likely.

Rather than believe that infertility treatment is the culprit, the researchers feel it's more plausible that the men have something else in common, for example, exposure to certain environmental toxins or faulty DNA repair, that increases their risks of both infertility and cancer.

There are times when seeking a diagnosis for fertility problems can result in other seemingly unrelated health conditions turning up. This study is another example of how a body's reproductive function can sometimes serve as a red flag indicator for overall health.

Upcoming Seminar on Fertility Preservation

On Monday, January 19th, I will be speaking to a public audience on the topic of egg freezing for fertility preservation.

Hosted by the Young Survivors Coalition, a non-profit breast cancer support and advocacy group, my primary focus will be on the potential for women who are newly diagnosed with cancer to protect their eggs from sterilizing effects of chemo or radiation therapy.

Our primary goal is to continue getting the word out there, so that pre-cancer treatment fertility preservation considerations are standard of care in the oncology field. I welcome attendance at these presentations by patients and professionals alike.

I like to present in a casual Q&A style, so please feel free to come with your questions.

The location will be one of the facilities of The Rose, an organization committed to helping all women be adequately screened for breast cancer.

When: Monday, Jan 19th, 6:30 PM
Where: The Rose, 12700 North Featherwood, Suite 260 Houston, Texas 77034


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This presentation is made possible in part by Fertile Hope and Organon, a part of Schering-Plough Corporation.

Another Great Day Houston

Following last July's show, I was asked to visit Great Day Houston again to talk more about fertility-sparing treatments for women who wish to delay conception.

Tune in to Great Day Houston with Deborah Duncan - Tuesday, October 21
at 9 AM Central on KHOU-Channel 11. Or watch online by clicking the Live Video link from http://www.greatdayhouston.com/ during airtime.

The techniques to retrieve and freeze egg cells for future conception are primarily offered to women who have just been diagnosed with cancer. We're working on collaborative relationships with cancer specialists and other professionals who can quickly refer patients for fertility preservation before they undergo sterility-causing cancer treatment.

As long as patients are willing to educate themselves and be fully aware of the process involved, women without cancer can also utilize fertility preservation technology to have a baby later.

Learn more about fertility preservation (for women and men) at http://babylater.com.

[Edited 10-31-08 to add link to view video here...]

Spreading the Word About Fertility Preservation

Last week, I had the pleasure of meeting with and speaking to the Educational Committee of the local Susan G. Komen Foundation group.

What a thriving organization! Just a few days after their annual Race for the Cure®, with participants this year numbering over 26 thousand, the women who lead Komen's educational charge gathered again in an office crowded with boxes of materials and mementos.

Lorianne Classen, a Health Education Specialist with M.D. Anderson Cancer Center and Komen volunteer, remarked that the meeting was particularly well-attended that evening, likely because of interest in our topic: fertility preservation.

Judging from the many raised hands with questions, including several from survivors and their loved ones, I'd say that interest in the concepts of preserving fertility for use after surviving cancer was indeed very high. Good questions. Poignant situations.

I left feeling very positive about sharing the realities of how women and men can take action to preserve their fertility before engaging in life-saving cancer treatment. I also came away seeing the need for education *now* is possibly greater than I thought.

As I emphasized to the Komen Education Committee, timing is crucial in this matter. I'll be continuing my pursuit of pre-need connections among oncology specialists and their patients -- through http://babylater.com -- so that the information about real hope for having a family isn't only wistful hindsight for cancer survivors.

For more information, visit the Houston affiliate of the Susan G. Komen for the Cure.