Foust’s breast surgeon was unsure and told her she thought it was likely that chemotherapy would impair her chances by damaging healthy eggs as fast as it killed other rapidly dividing healthy cells such as hair follicles.
Indeed, says Neelima Denduluri, a breast medical oncologist at Virginia Hospital Center, “chemo is a real risk to fertility.” Certain regimens, she says, “are more likely to cause infertility and decreasing of sperm count,” with up to 80 percent of patients affected, with exact rates depending on the type of cancer treatment and age at diagnosis.
Despite this, medicine has come a long way recently toward helping cancer patients — women especially — preserve fertility prior to treatment.
The most common and successful option for a woman with cancer is freezing an egg or embryo before undergoing chemotherapy or radiation. Once the patient decides she is ready to get pregnant, she is given estrogen and progesterone to prepare the lining of the uterus. The embryo is then thawed (or the egg is inseminated) and transferred into the uterus. Success rates specifically for cancer patients have not yet been studied. But in vitro fertilization (IVF) rates are around 50 percent for women younger than 35.
(For men with cancer, freezing sperm before treatment is far less invasive and less expensive.)
There are also experimental options such as ovarian tissue freezing, in which all or part of an ovary is removed and the outer area, which contains the eggs, is frozen in strips for later use. The ovary can be reimplanted when the patient is well. The procedure typically costs around $12,000; because it is experimental, research centers often provide funding, according to Teresa Woodruff, a professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University. Woodruff refers to such procedures as part of oncofertility, a new discipline that bridges oncology and reproductive medicine.
“I really appreciated there were so many advances in cancer therapy, yet so many young survivors were ending up sterilized,” Woodruff said. “There was a real need for a focus specifically in this field.”
Beginning the discussion
About 140,230 Americans younger than 45 will receive a cancer diagnosis this year, the American Cancer Society projects. The large majority of them are likely to survive for five years or more.
But only recently has fertility been factored into a patient’s treatment plan, according to Mark Payson, a reproductive endocrinologist at Dominion Fertility, a practice based in Arlington. When he speaks to breast cancer support groups, patients say that “only half of their oncologists talk to them about fertility options.”
Last month, a study by researchers at the University of Sheffield in England found that only 40 percent of young female cancer patients were happy with the way their doctors discussed the options they had to preserve fertility.