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Survivorship Series: Fertility

annekatzBy Anne Katz, PhD, RN 

This Monthly Survivorship Series, written by CKN Survivorship Editor, Anne Katz, is provided by CKN with permission from ONS.  We hope this series will become a useful resource that will help to facilitate dialogue between cancer patients, their loved ones and their physicians with a view towards improving the quality of life for cancer survivors.  

Some of the most dif­fi­cult work I do is talk­ing to patients about loss of fer­til­ity after can­cer treat­ment. Some­times the dis­cus­sion is with the par­ents of a teenager who is newly diag­nosed. I can see the pain and des­per­a­tion in their eyes: how could this hap­pen to their child? How can they make the right deci­sion when the fear of los­ing this pre­cious per­son over­whelms them? It is no eas­ier when I talk to a young adult, mar­ried just a few months, who now faces a delay in start­ing treat­ment if he wants to freeze sperm. And more often than these exam­ples are the cou­ples who so des­per­ately want a baby — but treat­ment years ago makes this  impos­si­ble. Why did no one tell them at the time about fer­til­ity preser­va­tion, they ask. Why?

If any of you have had these kinds of con­ver­sa­tions with patients, you know how heart­break­ing it is — for the nurse, the physi­cian, but mostly for the patients. I’m not sure that we do a great job with this for dif­fer­ent rea­sons. For the patient there is panic and fear, for the health care provider there may be a reluc­tance to delay treat­ment. But ulti­mately it is the patient who is left to deal with the fall out — months of try­ing to con­ceive at some point in the future, the dis­ap­point­ment of not know­ing what the con­se­quences of treat­ment on fer­til­ity might be, the lone­li­ness of not being able to have a bio­log­i­cal child.

Yes, cou­ples can adopt. Yes, in cer­tain cir­cum­stances a man has the time to freeze sperm. Yes, if the woman has a part­ner and has the time before treat­ment she can pro­duce eggs that are mixed with her partner’s sperm and the embryos are frozen. But other than that, the options for fer­til­ity preser­va­tion are lim­ited and exper­i­men­tal. Freez­ing ova or ovar­ian tis­sue is still an exper­i­men­tal pro­ce­dure with very low lev­els of suc­cess­ful preg­nan­cies. And not every­one has access to spe­cialty cen­ters that even offer these tech­niques. Or the cost is pro­hib­i­tive. Or there is no time.

Infer­til­ity after can­cer is a silent and tragic chal­lenge that many patients face. How can we best help them?

Read Anne’s Last Post here.

Related Post:  Cancer, Chemotherapy and Children:  A Cancer Survivors Personal Story Regarding Fertility

 

 

 

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