Today we’re going to explore the questions to ask your doctor re: fertility when you’re diagnosed with cancer as an adolescent or young adult. Megan Scherer, co-founder of Worth the Wait, interviewed Dr. Wendy Vitek, a reproductive endocrinologist and oncofertility expert at the University of Rochester – Strong Fertility to find out more.
You’ve been diagnosed with cancer. Here are 9 questions you’ll want to ask your oncology team before treatment.
Q. Is my fertility at risk?
Dr. Vitek says that if you’re diagnosed with testicular, ovarian or uterine cancers, there’s a good chance you are thinking about fertility because these cancers directly affect your reproductive organs. Other cancer diagnoses and fertility risks are less obvious though. For instance, if you’re able to receive chemo and/or radiation it may impact your fertility.
All oncologists should follow The American Society of Clinical Oncology (ASCO)’s guidelines that require anyone of reproductive or pre-reproductive to be consulted about fertility risks. Dr. Vitek emphasizes that your doctor shouldn’t assume anything based on your fertility history, race, or sexual orientation. It’s important to ask your physician this question before you start treatment if they don’t bring it up. Any potential fertility side effects of treatment will be documented in the consent form your physician reviews with you before surgery, chemo, and/or radiation.
Q. Is it safe to delay my cancer treatment to preserve fertility?
“This is a complex conversation that needs to take place as soon as possible. Your oncologist and reproductive endocrinologist will want to work together to determine if you can delay your treatment 6 days [the time it takes for a man to bank sperm multiple times] or 2-2 ½ weeks [the time it takes a woman to complete egg freezing].
My patients with solid tumors generally have time to preserve while those with hematology malignancy may have to start treatment quickly and face greater risks with an egg retrieval. Most male patients can bank one to two sperm samples even if they are critically ill,” shares Dr. Vitek
If you’re considering ovarian or testicular tissue cryopreservation, you may be able to have it done during port placement and it may not delay your treatment.
Q. Can my fertility risk change over time?
If you need additional treatment Dr. Vitek explains that “your physicians should have an ongoing conversation about fertility, so you know your long and short-term fertility risks.”
Q. Is ovarian suppression an option for me?
Lupron shots may be used to temporarily suppress hormones that put a female into menopause. This can help your ovaries withstand chemo treatment. This treatment can be used even if you’ve already preserved eggs. Dr. Vitek notes “Lupron has side effects though and should only be used for 6 months or less.”
Q. What fertility options exist for me if I’m LGBTQ+?
“It’s important to talk to your physician about what you envision for your future family. There are options like reciprocal IVF, where you carry your partner’s embryo, egg, sperm and embryo donation and fertility preservation for transgendered people,” shares Dr. Vitek.
Q. Will immunotherapy affect my fertility?
“There is less research on how immunotherapy affects fertility because there are many new options, and we don’t have enough data yet. Some immunotherapies may affect the pituitary gland which is important to reproduction. When in doubt, physicians should be counseling and erring on the side of caution, so patients have more options in the future,” adds Dr. Vitek.
Q. What if I can’t preserve fertility or carry a baby?
Some patients are too ill to go through with egg preservation. If you’re not able to pursue fertility preservation for whatever reason, there are alternate ways to build a family. Options to consider include gestational surrogacy (where a woman carries a baby not genetically related) or donor gametes (using a donated egg, sperm, or embryo).
Q. How soon after cancer treatment can I start a family?
“I recommend waiting 12-18 months after you’re finished with treatment to start a family, but you should ask your physician.
About a year after treatment is a good time to get your ovarian reserve checked (simple blood test) or do a semen analysis if you want to see how treatment impacted your fertility to plan ahead for future family building.
If you have breast cancer and your treatment includes hormone/endocrine therapy, timing is critical as this therapy typically lasts 5-10 years which may coincide with your peak reproductive years,” shares Dr. Vitek.
Q. What resources exist for family building and/or fertility preservation?
Dr. Vitek says that it’s important to talk with a nurse navigator and/or social worker to find out what’s available to you. Some fertility clinics offer discounts on medications and procedures. Resources like Worth the Wait may help with fertility preservation or family building if you’re in need.
Other important factors to note.
There are different options for fertility preservation depending on your age.
Most girls start puberty around age 9-10 and typically produce mature eggs one to two years later. Pre-pubertal girls may have the option to freeze ovarian tissue through surgery. There is some uncertainty with this type of fertility preservation but there have been live births from this method.
Boys start puberty around age 11-12 and can bank sperm around age 13-14 or older. For pre-pubertal boys, testicular tissue cryopreservation through surgery may be an experimental option.
A woman’s fertility starts declining in her mid-30s and there’s a sharp decrease in her early 40s. A physician can measure a woman’s egg reserve before pursuing egg freezing.
Men generate sperm in their 60s and 70s so age is less of a factor.
Be sure to include loved ones and your care team in your conversations about fertility.
Dr. Vitek recommends, “including [if applicable] your partner, parents, nurse navigator, oncologist, reproductive endocrinologist, social worker, and anyone who may be supporting you financially in conversations about future fertility.”
Thank you to Dr. Vitek for sharing her expertise and passion with the Worth the Wait community.