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Fertility takes center stage at SABCS

BY SUSAN MCCLURE | DECEMBER 8, 2011

In an educational session that kicked off this year's San Antonio Breast Cancer Symposium, Teresa Woodruff, PhD, noted that survivors experience depression and anxiety because of sterility. Adult survivors of childhood cancer are often afraid to begin dating because they don't want to have that conversation with someone at an early stage in the relationship but are uncertain as to when to initiate it. Young men and women have the same concerns, but these concerns are heightened among young breast cancer patients.

Fortunately for me, I was already married when I learned that I had cancer. I was also the mother of a wonderful two-year-old boy named Ryan, who remains the best and brightest light in my life. That said, at 35, I was devastated when my oncologist told me that I wasn't going to be able to have more children. I had always thought I would have two or three kids and the thought of Ryan being an only child, with no sibling to grow old with, made my heart ache. It still does.

Lance Armstrong announced publicly that he banked his sperm – that was one of the first public acknowledgements that cancer treatment can cause sterility and patients should do something to preserve their fertility before treatment.

In regards to the logistics of preserving one's fertility, men have an easier time, but not all men have been offered sperm banking. There needs to be better patient navigation in adequate time to ensure that men are able to father future generations. Options for women have been available for some time, but are not always used. Navigation is more difficult – Women have to go from cancer care to reproductive endocrinology and then back to cancer care again which is difficult, and quite honestly, scary and stressful.

Woodruff suggested that patients and doctors know that fertility conversations should happen, but she isn't convinced that all newly diagnosed patients are thinking about fertility, even if it is more widely known. What about you? Did your healthcare team bring it up? Were you given a chance to fully understand your options?

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COMMENTS

In 1989, I was diagnosed with pelvic Ewing's sarcoma at age 15. I had a year and a half of chemo and a month of radiation at one of the top cancer hospitals in the country, with no mention of preserving my future fertility. Although I was a teen, I was concerned, and asked about the viability of my eggs, what effect the treatments would have on them and my uterus. I posed these questions to my oncologists, radiation oncologist, any doctor who would listen. Instead of being taken seriously, I was told not to worry about it now, “you’re so young,” that it's so far in the future, and "let's just focus on getting you well again." Well, that "far future" is now here and I'm left with a non-functioning left ovary, a half-scarred uterus, and 2 natural pregnancies in 2009 that ended in devastating miscarriages. Late effects from the 5400 cGy of radiation have included severe osteoarthritis in my left hip, and 2 septic hip infections that resulted in surgeries, the most recent (Oct 2011) of which resulted in a resected femoral head with no hope of prosthetic replacement due to recurrent infections. Recovery has been slow and I'm still walking with crutches, unable to bear a child, let alone care for it as I can barely take care of myself. At 37, my body feels like an 80-year-old, and is not healthy to carry a pregnancy to term. I can GET pregnant, I just can't STAY pregnant. It's both disheartening and liberating to see stories on the news lately of teenage cancer patients asking the same questions I did, advocating for themselves, and preserving their fertility while they still have the chance and choice. I just wish doctors were that willing to applaud me back then, before it was too late to do anything about it. Given my health problems due to late effects, the location of massive scar tissue in relation to where a potential baby would need room to grow, and the lack of energy needed, a child is just not in the cards anymore. It's taken me 2 years to come to terms with living child-free, and organizations like RESOLVE and i[2]y young adult cancer foundations have helped tremendously, although being around infants is still difficult. I hope that medical schools will begin training their doctors and nurses to take future fertility concerns seriously, no matter the age of the patient, as infertility affects not only a person’s physical body, but their emotional and psychological well-being as well.
- Posted by Carolyn Cerrito 12/8/11 6:01 PM

I was diagnosed with IDC in October 2010 at the age of 32. Sterility from chemotherapy was mentioned, but briefly. Basically, my oncologist told me I'd have to navigate through it myself, which proved to be complicated, expensive, and I felt would delay treatment. I didn't consider it very much and proceeded with treatment.
I do feel some sadness that I may not be able to conceive, and am hoping that my path to motherhood becomes clearer over time.
I wish there would have been more emphasis on fertility issues at the beginning and that I would have had help during such a stressful time to consider my options.
Thanks for the topic.
- Posted by Melisa 12/16/11 10:03 AM

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