Fertility

Before getting into infertility, let's talk briefly about fertility. If you are already pregnant, ask your long-term follow-up team if you face risks that non-survivors don't -- if so, consider enlisting a high-risk obstetrician. In particular, female survivors who received pelvic radiation might have complications that could lead to premature labor or a low birth-weight baby. A new study (July 2010) has found that female survivors who were treated with radiation to the uterus and ovaries before they hit puberty are at risk of having stillborn babies or an infant who dies shortly after birth.

If you are still in the process of considering whether biological parenting is right for you, one of the biggest questions you may face as a childhood cancer survivor is whether your disease is genetic and could be passed on to your offspring. In most cases, the offspring of childhood cancer survivors are just as healthy as the offspring of people who have never had cancer. But if the risk of cancer to your future children would impact your choices about becoming pregnant, you might want to consider genetic testing and/or talk to a genetic counselor. Specifically, survivors of retinoblastoma are at risk for passing the hereditary gene for retinoblastoma to their offspring. 

Fertility is a sensitive and emotional topic. It's especially difficult for cancer survivors, because some cancer treatments cause fertility problems in both men and women. Oftentimes, especially in the case of a young child with cancer, the family's panic to start life-saving treatment as quickly as possible overrides questions about future fertility. It isn't until many years later that a lot of childhood cancer survivors come face to face with the effect their treatment had on their fertility. 

The good news is that modern medicine continues to make advances, both in treating infertility and in minimizing the late effects of cancer treatment related to fertility.

Photo Credit: Flickr user goldberg

What is Infertility?

Infertility is the inability to start or maintain a pregnancy. The American Society of Reproductive Medicine defines infertility as the inability to conceive after one year of unprotected intercourse in women under the age of 35. Some cancer treatments, including radiation to the testes or ovaries and alkylator drugs:

• May cause infertility
• May increase the difficulty of conception
• May make maintaining a pregnancy more difficult.

Other factors that may affect a childhood cancer survivor's fertility include:

• Type and location of cancer (most risky:  for males, direct radiation to the testes; for females, direct radiation to the ovaries)
• Age and developmental age at time of diagnosis (survivors treated before puberty usually have less risk to their fertility than those treated after puberty)
• Gender
• Types and dosages of drugs (most risky:  high doses of alkylating agents, high doses of radiation, or total body irradiation)

If you are concerned about infertility, talk with your doctor about the type of cancer and treatment you had as a child. Some treatments that were previously thought to cause infertility have actually not affected fertility. This information may affect your decisions regarding birth control - but you should never assume that the treatment you received is a substitute for contraception. You may also want to consult an infertility specialist.

Choices                                                                         Image courtesy Flickr user gabi_menashe

Fertility Treatment:  If you are infertile, and you'd like to have a child, many options are available, including fertility cycle enhancement, donor insemination, donor eggs, in-vitro fertilization, and surrogacy.

A new development in the field of fertility treatment for those who have not yet undergone cancer treatment is ovarian tissue freezing where the ovaries would be removed and frozen prior to therapy and thawed and replaced after therapy.

For a slideshow presentation about some of these fertility issues, click the below image to view a PDF presentation from Fertile Hope, given at our DC Rise To Action conference in 2008. 

Adoption:  Many infertile couples choose adoption rather than infertility treatments, or they decide to adopt after infertility treatments have failed. If you are considering adoption, you have a variety of choices, including domestic parental placement, domestic waiting child/foster care adoption, or international adoptions. Each has its own benefits and risks. Several factors to consider prior to adoption are cost, ethnic, heritage, age of child you wish to adopt, whether you're prepared to handle a child who has been abused or neglected, and whether you can travel at a moment's notice to complete the adoption process. If you know that you'll want to adopt as a back-up plan if fertility treatments don't work, start looking into the process while you're still trying to conceive biologically because the adoptive process can be a very lengthy one. 

Remain Childless: Some infertile couples choose to remain childless. This can be a rewarding choice if you have accepted infertility and chosen other ways to fulfill your desires to have children in your life; for example, you might choose to volunteer at a school, camp, or non-profit organization, or you can take an active role in the lives of children that you are close to - nieces, nephews, and children of friends.

The Psychological Impact of Infertility

The overwhelming medical decisions and uncertainties associated with infertility can create one of the most distressing life crises facing a couple or individual. The long-term inability to conceive a child can evoke significant feelings of loss. If you find yourself feeling anxious, depressed, out of control, or isolated, you are not alone. However, if these feelings persist, seek professional help.

There are certain times during infertility treatments when discussion with a a mental health professional about infertility options and your feelings can both clarify and aid in your decision making. For example, consultation with a mental health professional may be helpful to you and your partner if you are:

• At a treatment crossroad
• Deciding between alternative treatment possibilities
• Exploring other family building options
• Considering third-party assistance
• Having difficulty communicating with each other or if you have different ideas about directions to take.

For more information, watch the below presentation, given at RTA-Houston in April 2010, on "Becoming a Parent after Cancer," given by Leslie Schover, PhD, at MD Anderson's Department of Behavioral Science. Due to length (approximately 20 minutes), this presentation - with audio - has been split into 2 parts:

Part One:

Part Two:

Resources and News Articles

"Survivors of Childhood Cancer May Face Increased Risk of Stillbirth, Neonatal Death" (CNN, 7/22/10)

"Testosterone Deficiency in Childhood Cancer Survivors" (ScienceDaily - 6/3/10)

"Babies Born to Childhood Cancer Survivors Do Well" (NY Times - 10/7/09)

"Surviving Cancer 'Baby Impact'" (BBC News - 8/12/09)