When cancer is diagnosed in younger patients, there are a number of unique issues that need to be considered that older patients do not face. Fertility is one of the most important concerns reported by adolescent and young adult (AYA) patients as many hope to survive their disease and go on to have children in the future. Research focused on fertility in AYA survivors has increased in recent years, but there remains a great unmet need for comprehensive reproductive health counseling at all stages of the cancer continuum; before treatment begins and in post-treatment survivorship care.
It was our second trip to the fertility specialist in two days and her sixth medical appointment that week. The sun was warm, the windows down, and cars were whizzing past us on the highway the day when my 26-year-old daughter, Lindy, turned to me and said, “You know Mom, it has never occurred to me that I am going to die.” I gripped the steering wheel and felt my shoulders tense, I realized that Lindy dying was all that I could think about.
I’ve endured thousands of needle pricks, undergone painful surgeries, and have withstood innumerable grueling treatments. I’ve been sick, bald, weak, over-medicated, under-medicated, poked, prodded, pained, and simply desperate for life. I’ve been triumphant, encouraged, accomplished, fortunate, blessed, and hopeful. I’ve gained insight, wisdom, and more medical knowledge than I could have ever imagined. My perspective has flourished and evolved. I have found a depth of joy that many never will. I’ve grieved loss. I’ve suffered hardship. I’ve authentically experienced mortality. I’ve overcome. I am brave and strong and alive. Yet among those things, I am also overwhelmingly burdened.
“I’m sorry to tell you, it’s cancer. You will need an emergency hysterectomy followed by chemotherapy and radiation.” With one fell swoop, my life, dreams, and plans dramatically changed. Not only did I learn that I had cancer, but also that my chances of bearing children were erased.
As both a health lawyer and a new mom I have a message to share: oncologists and young adults diagnosed with cancer need to have the fertility talk. If the doctor doesn’t bring it up, the patient should.
It is well known that cancer treatments can lead to infertility. That is the nature of the beast. But it doesn’t mean that someone fighting cancer can’t have children in the future. However, it may be necessary to take steps to preserve fertility in advance of treatment so that children do remain an option.