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In vitro fertilization is one path to parenthood for cancer survivors. Photo by iStock

Fragile Fertility

Here's what cancer patients need to know if they want to start (or grow) a family.

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Dr. Laxmi Kondapalli. Photo courtesy of CCRM.

Cancer is an ugly word, but it’s no longer a death sentence. As early detection and better treatments lead to higher survival rates, patients can turn their attention more quickly to life after cancer—including “fertility, family building, and parenthood,” says Dr. Laxmi Kondapalli, a reproductive endocrinologist at the Colorado Center for Reproductive Medicine. “Patients are asking that oncologists talk about these things at time of diagnosis.” This burgeoning medical field, which links oncology and reproductive science, is called oncofertility, and because it’s still so young, Kondapalli offers the following advice for cancer patients who have dreams of becoming parents.


How cancer can affect a person’s fertility:
According to the National Cancer Institute’s Childhood Cancer Survivor Study, which has followed almost 36,000 childhood survivors since 1994, three factors have the biggest impact on fertility: age at diagnosis, the type of treatment, and cumulative effects of treatment dose. “Certain types of chemotherapeutic agents are more toxic than others,” Kondapalli says. Radiation can also damage sperm and eggs and restrict blood supply to a woman’s uterus, limiting her ability to carry a pregnancy to term.

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What patients should ask their doctors about how treatment could affect reproduction:
Start with the basics: Will treatment impact my sperm or eggs? Are there going to be issues with pregnancy? Will it be safe for me to carry a baby in the future? If chemotherapy is part of the recommended treatment, ask about the specific kinds of chemo and possible long-term complications.

The options for starting a family if treatment could reduce fertility or endanger a pregnancy:
One path is assisted reproduction, which means using sperm or eggs that were frozen before undergoing treatment. Patients with partners may want to consider embryo banking (where the sperm and egg are frozen together). Harvesting eggs takes about two weeks; men can bank their sperm the same day as diagnosis, and the samples can survive for decades. If the cancer is too aggressive and there isn’t time for banking sperm or eggs, or if pregnancy is considered unsafe post-treatment (as with women who are at high risk of recurrence), surrogacy and adoption are good alternatives.

What patients who want to conceive need to know about passing along cancer genes:
For patients who undergo in vitro fertilization (IVF), Kondapalli says, doctors offer something called preimplantation genetic diagnosis, in which they test the embryos for a specific gene mutation. Caveat: If the cancer is not associated with a known gene mutation, the test does not apply.

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