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.

Putting the Risks of IVF in Patients' Hands

Australia is home to some renowned fertility specialists. They've also developed a reputation for research on the offspring of IVF, and the most recent information is now being provided in brochure form to patients in Victoria. The brochure is produced by the Victorian Assisted Reproductive Treatment Authority, an Australian institute that helps regulate the use of A.R.T. in that country.

The news about how "The Children of ART" are doing is important to the patients I see at Houston Fertility Center (Here's a link to a related newsletter, now archived on CallDrK.com.) IVF has been helping people conceive babies for more than 30 years now, so current patients can benefit from long-term studies on their development.

So far, the news is overwhelmingly positive, as this brief, related news piece from the Herald Sun explains. One of the biggest hurdles to health for both baby and mom is multiple pregnancy (often a precursor to preterm and premature births), and the fine-tuning of IVF techniques has resulted in far fewer of those. The article also mentions parenting anxiety as being more prevalent in IVF mothers, but I'd wager there are some cultural differences there. Seems to me that in this day and age, most savvy moms have a lot on their plate to worry about, so some anxiety comes with the territory -- no matter how your baby came to be.

The data on a topic as broad as "development of children born from IVF" will always be changing and sometimes debatable. The important thing is that it's out there, that researchers are continuing to explore with long-term studies, and the information is in the patients' hands.

~Dr. Sonja Kristiansen

Get Your OB On Board: Time Is (Almost) Everything

Being in the right place at the right time can make a difference in your life. It's true for getting pregnant, too. And your OB/Gyn knows how key timing is to pregnancy and delivery.

Does your OB also know how time impacts your ability to get pregnant? If he or she doesn't, you should.

At Houston Fertility Center, I've heard from many new patients their personal reports of months, and sometimes years, full of worry that something is wrong -- all the while being told by their primary care physicians that the best thing to do is de-stress and have patience. Nothing's wrong. Relax and you'll be pregnant in time.

It's true that stress can be a fertility factor, since it wreaks havoc on your hormones, which can result in lessened fertility. But many patients have health conditions that might easily be diagnosed and treated so that conception and pregnancy can occur -- stress or no stress. (And if stress really is your primary fertility problem, there are plenty of recommended steps you can take to change that.)

There's one factor in the fertility equation that treatment can't do much, if anything, about: time and your age. And there's nothing that has a greater impact on your chances for pregnancy.

While we have incredible medical technology that can help women get pregnant all the way into their 40's, the natural fact is that women's fertility levels decline significantly as they get older. That means the older you are when you're trying to conceive, the more effort it may take. It also means your chances of conception get smaller.

Age and time are so important to fertility, experts recommend you consult a reproductive specialist if:

you haven't become pregnant after a year of trying and you're a woman who's younger than 35 years

or

you haven't become pregnant after 6 months if you're 35 to 39 years old.

And women who are 39 years or older should seriously consider talking to a specialist as soon as getting pregnant is a goal.

The American Society for Reproductive Medicine explains details of the age-fertility connection in their related booklet.

Besides the reproductive change that every female body goes through (and that actually begins long before most of us are aware of), many infertility-causing conditions are silent -- no symptoms to cause you concern, all the while the condition becomes a growing barrier to your body conceiving a pregnancy. If you have one of these barriers, which includes structural conditions, trauma, or infections, your own baseline fertility will quite possibly become worse over time.

If you've heard "Everything's fine," a little too often from your OB/Gyn, there's no harm in seeking a second opinion. You might benefit from some easy, inexpensive blood testing or semen analysis, or like some patients learn, it may only take a thorough medical history and brief educational tips on optimizing your trying-to-conceive efforts.

More of my thoughts about timing and conception:

Trying to Get Pregnant After 30 - Time to Panic? - a blogpost about how moving along with your plans is good, but stressing out about it defeats your purpose

Timing Is Everything: When You Want a Baby Later - a newsletter article on using ART to delay conception

a quick intro to Fertility & The Mind-Body Connection

~ Dr. Sonja Kristiansen MD

Is Your OB On Board With Baby-Making?

When questions about getting pregnant arise, most women first turn to their OB/Gyn. You probably even rely on your OB/Gyn as your primary care physician, especially if you have health insurance. Patients typically count on their OB/Gyns to alert them when it's time to see a fertility specialist.

Unfortunately, though, a lot of woman also find that their OB's may not act very quickly when the patient expresses more than just fleeting thoughts but worries about getting pregnant.

That's why I and many of my colleagues spend at least some of our time educating other physicians about the differences in fertility levels and about how those differences may show up in their otherwise healthy patients.

If you're not yet a fertility patient (and you may never have to be!), here are a few related basic points to look into and discuss with your OB/Gyn if your goal is conception:

How long have you been trying to conceive?

Do you know when your most fertile times are each month, based on your cycle?

Do you have any family members who had trouble getting pregnant?

And if you're in your mid-30's or older and are still thinking "maybe someday"... it's time to discuss plans now with your physician, even if you don't plan on putting it into action immediately.

Knowing when to seek care from a fertility specialist can really make the difference between having a baby or not. If your OB/Gyn doesn't know what to look for or doesn't ask you the above questions, start the ball rolling yourself.

How Do Fertility Patients Feel About Donor Anonymity?

I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.

The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.

Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.

The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.

This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.

~ Dr. Sonja Kristiansen MD

Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?

Disney and I Both Hope You Won't Need My Services

The other day I saw a headline that really pulled me in -- "Disney/ABC Television Group Sponsors The American Fertility Association's Infertility Prevention Program".

The combined images of Disney and infertility were curious, indeed. When was the last time you thought about Mickey Mouse and fertility problems at the same time? But that odd juxtaposition is actually the result of positive progress in terms of fertility education.

Truth is, as a mother and physician, I hope you don't need the services of a fertility specialist, now or later. But another truth is explained in this recent blogpost on EmpowHer, "STDs and Infertility", where the author, Stacy Lloyd, explains how some young women are destined for infertility down the road. And it's those facts that make me smile when I read about Disney/ABC TV granting funds to the American Fertility Association (AFA).

The AFA works hard to not just support men and women who are struggling with infertility, but also to educate everyone about the realities of normal fertility. When young people arrive at the point in their lives when having a baby feels like the right thing to do, some are shocked to find that, all along and without their knowledge, their bodies have built up roadblocks against conception. Programs like the AFA's "Infertility Prevention Handbook" and their outreach gatherings at a broad variety of venues (even manicure salons!) can spread the message that steps can be taken before infertility is a fact in someone's life.

Since Disney definitely brings to mind "family", I think it's fitting that the corporation supports efforts at keeping couples from having to consult fertility specialists in the future.

You can find out more about the AFA at their website.

IVF Works for Hispanic Women, Too

Many of my patients may be relieved to hear this piece of research news from a colleague in San Antonio: Hispanic women are just as successful with IVF as are non-Hispanic anglo women.

There's no particular reason to believe otherwise, but a previous nationwide study that compared IVF success rates among women of multiple ethnicities showed that Hispanics were 13 percent less likely to have a baby following the procedure. They were, however, just as likely to get pregnant via IVF as anglo women.

The newer study is smaller and included only patients at one clinic. Also, nearly all the Hispanic study subjects were Mexican-American, unlike the larger, national study. It also showed that while getting pregnant is comparable in terms of percentages, Hispanic women were more likely to miscarry, although the researcher, Dr. Robert Brzyski, says that's likely a chance occurrence.

Of particular interest is the clear difference in cause of infertility between whites and Hispanics. White women had more endometriosis and Hispanic women were more often diagnosed with tubal factor infertility.

Tubal blockages and resulting infertility were the original reason for IVF being invented. As long as other factors aren't impacting a woman's chances for pregnancy success, using IVF to work around tubal factor infertility is very effective.

Like Dr. Brzyski's practice, Houston Fertility Center is in the middle of a richly diverse metropolitan area. With Spanish-speaking staff and educational efforts within the Hispanic community, we provide every opportunity possible to bring home the message to women that infertility is treatable. I'm happy to be able to add this piece of good news to our message.

~Sonja Kristiansen, M.D.