Teen Girls With Cancer: How to Preserve Fertility
If your child gets diagnosed with a serious illness like cancer as a teen, it can raise a lot of scary questions. One question you might have is whether your child will be able to have kids in the future.
It's true: For young women with cancer, certain medications and procedures like radiation and chemotherapy may risk harming future fertility or delay the ability to have children, according to the National Institute of Child Health and Development (NICHD). But there are things that can be done to help preserve the ability to have a baby in the future. This is known as fertility preservation.
What is fertility preservation?
Fertility preservation is a series of things that might be done to make sure someone can still have children in the future, according to the NICHD. What exactly is done is based on the nature of the cancer treatment, age, the timing of treatment, and whether they’ve gone through puberty already. After the patient has thought about what they may want in the future, they can work with their doctor and family to come up with a plan to help preserve their fertility. This plan is based on their desires, the specific disease, and treatment options.
How does fertility preservation work?
There are actually a few types of fertility preservation for young women. Each one may be used alone or along with other forms.
Gonadal shielding: The simplest form of fertility preservation is known as gonadal shielding. This means that during radiation treatments, the ovaries (gonads) are shielded during treatment by wearing a lead apron. If you’ve ever had an X-ray, you might be familiar with wearing this type of apron. It may also be possible to aim the treatment away from the ovary area altogether. Radiation treatments are done alone or in conjunction with chemotherapy or medication. This form of fertility preservation is available for all ages and is not dependent on puberty status. Remember: Females are born with all the eggs they will ever have already in their bodies, so fertility preservation is key even at an early age.
Oocyte cryopreservation: This process, also called freezing eggs, is when unfertilized eggs are retrieved and stored. Similar to this is embryo cryopreservation, where mature eggs are removed and fertilized in the lab with sperm from a donor or partner. The resulting embryos are frozen and stored until the patient is ready to use them. This process is also known as in vitro fertilization and is also a technique used in families undergoing fertility treatments. These two methods are the preferred methods.
Ovarian transposition: The final method available for women to preserve fertility is known as ovarian transposition. If the young woman is not a candidate for gonadal shielding (for example, if the cancer is in the pelvis), surgery is performed to remove all or part of the ovarian tissue and perhaps the fallopian tubes to another area of the body that will be able to be shielded. A common example would be to place the ovarian tissue in the abdomen.
There are other fertility preservation methods being studied, but they are still considered experimental.
Are there complications from fertility preservation?
The biggest risk factor for most fertility preservation methods is simply that they may not work. But remember, regardless of cancer treatment history, about 1 in 8 people will struggle with fertility issues.
The medications given during egg retrieval do have some side effects, like drowsiness, amnesia, sometimes even vomiting, which may be unpleasant. And because certain cancers may not tolerate the hormonal effects of these drugs, they may not be an option for everyone. There are also potential complications from minor surgical procedures that may be required, including from the anesthesia.
Who is a candidate for fertility preservation?
The most common issues with fertility preservation will be age, the stage of the cancer, and the timing of the treatment. For example, if the patient has not yet undergone puberty, you will not be a candidate for oocyte or embryo cryopreservation, but gonadal shielding and ovarian transposition may still be useful.
If the patient doesn't have partner and does not wish to use donor sperm, but is past puberty, they will have to use methods other than embryo cryopreservation.
And if the cancer is too severe to allow the time or ability to withstand the medical treatment required to retrieve the eggs, whether for embryo or oocyte preservation, you will need to skip this option.
What are pregnancy rates after fertility preservation?
Fertility rates vary widely. They depend on the baseline fertility prior to the procedures, which procedure was done, and other risks of using fertility methods. This is why one of the most important medical team members will be the reproductive endocrinologist.
A reproductive endocrinologist is an obstetrician who specializes in fertility. Working with one of these doctors will give the the best chance at fertility preservation.
Talking to a younger child or teen about fertility preservation
If your daughter has been diagnosed with a condition that requires treatment with some chemotherapy agents or radiation, like cancer, you may wonder what the effects will be on her reproductive life after the cancer is cured. The first thing you need to do is to gather information.
Talk to your daughter about the subject of fertility. This may be one of the furthest things on either of your minds, but it is an important topic to broach. Explain that it’s a conversation that you will need to have with your doctor and team.
As you begin to have the conversation with your child’s doctor, you will want to ask questions like:
- What’s the likelihood that the chemo or radiation will cause early menopause?
- Are you using medications or procedures that may harm the fertility for the future?
If the answer to the previous question is yes, you should also ask:
- What are the steps we can take to help preserve her fertility?
- What are the risks? Benefits? Alternatives?
- Do you have to make any decisions right now?
- Can treatment wait for the fertility preservation or do you need an alternative plan?
In the end, Michael Grossman, M.D., a reproductive endocrinologist, reminds us there are always different paths to have a family.
“Even if her own eggs were lost in the process of saving her life, there are always options for family-building,” he tells HealthCentral. “There are lots of good babies waiting to be adopted into happy homes. Donor eggs, either anonymous or related, can provide the experience of pregnancy, delivery, and breastfeeding.”
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