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The Next Generation

Building a family after cancer, con't.

In addition, technologies for freezing eggs -- rather than embryos, which are eggs that have been fertilized with sperm -- has vastly improved, Fisseha says. This is a breakthrough for teenagers and women who may not be in committed relationships and dont have a male partner to provide sperm.

However, for some, the cost of egg or embryo preservation is prohibitive: It can range from $16,000 to $18,000 in some cases. But thanks to a partnership with the Livestrong Fertile Hope initiative, the U-M Center for Reproductive Health offers the service to qualified cancer patients for as low as $5,500.

"We don't want money to be the reason patients aren't doing this,"Fisseha says. "It's too important."

OVARIAN SUPPRESSION

For women who cannot wait to begin chemotherapy that may damage their ovaries, a new, experimental option is available. Monthly injections of gonadotropin releasing hormone analog (or GnRHa) are given to women during chemotherapy with the goal of temporarily shutting down the ovaries, Fisseha says.

The approach evolved from the observation that the ovaries in pre-pubescent girls who receive chemotherapy usually do not fail after treatment. Fisseha says researchers think this is because ovaries that are not active are less of a target for damage.

The benefits of GnRHa are not yet definitively proven, Fisseha says, but there is little risk of harm and the treatment is relatively low-cost and often covered by insurance.

"A recent study in the Journal of the American Medical Association showed significant benefits," she says. "It may not be for everybody, but at least some portion of the patient population may benefit."

LeElla Flake may be one of those patients. Flake, a breast cancer patient, received the drug as part of a clinical trial. A year after her ovaries woke up, she became pregnant with her son.

"I didn't focus on the cancer anymore. That didn't scare me. It was 'Oh, I want a baby; what am I going to do about that?'" says Flake of the moment when she learned cancer treatment could impact her fertility. "And so when they brought up the clinical trial I just felt like I could focus on the cancer, because the possibility was back."

ADOPTION

Erin Miller had always expected to adopt a child. Miller was 12 years old when she learned that the abdominal radiation she had received as a 5-year-old for a Wilms' tumor had caused ovarian failure. She had cousins who were adopted, so she was pretty comfortable with the idea of adoption.

But after Miller married her husband, the couple decided to pursue in vitro fertilization using eggs donated by her sister. After three cycles, though, it was clear that Miller's uterus was compromised as a result of radiation therapy and couldn't support a pregnancy.

So in 2002, the Millers embarked on the process of adopting a child. On their first attempt, the birth mother changed her mind. So the Millers waited patiently for another two years. But then a move to Grand Rapids caused them to switch adoption agencies. The very day their paperwork was approved, an expectant teenager chose the Millers to raise her child. The baby -- a girl they named Natalie -- was born three weeks later.

p>"We had been through the classes and we kind of knew what to expect, but it's sort of a surreal feeling: You're really letting us leave with this baby?" Miller says. "With adoption, you wait, but you never know when that's going to change."

And it may change again for the Millers: The family is seeking to adopt again.

WHO'S AT RISK?

All cancer treatments do not cause infertility, but the therapies or factors listed here increase the risk:

• Patients receiving radiation therapy to the abdomen or pelvis
  
  
• Patients receiving alkylating agent chemotherapy or certain other forms of chemotherapy depending on the dose and duration
  
  
• Women 30 and older who are receiving cancer treatment

Always talk to your doctor to understand the impact of your treatment on your fertility and other aspects of your life. To get a better sense of your risk, visit FertileHope.org.

 

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This article first appeared in the Winter, 2012 issue of Thrive.
Print Thrive Magazine; Winter, 2012