Having a Baby After Breast Cancer: Oncofertility Services Help Make Dreams a Reality

Some 80,000 young adults ages 20-39 — and thousands of children — are diagnosed with cancer in the U.S. each year, according to the American Cancer Society. Some of them celebrate the end of treatment only to discover later in life that they are infertile.

Fertility preservation is a subject that is broached more often today, particularly as the numbers of younger people with cancer are rising, as are the rates of survivors. And because there are approximately 370,000 new cases of breast cancer diagnosed in the U.S. every year, a good number of the conversations surrounding fertility occur with women undergoing care for breast cancer.

On the positive side, thanks to oncofertility services such as those offered throughout Baptist Health Cancer Care, more cancer survivors fulfill their dreams of becoming parents.

Among the services offered by Baptist Health Miami Cancer Institute and the Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, also part of Baptist Health, are fertility education and counseling.

Elina Melik-Levine, ARNP, a nurse practitioner and educator at Baptist Health Miami Cancer Institute

“Ideally we meet right after their initial diagnosis,” said Elina Melik-Levine, ARNP, a nurse practitioner and educator at Miami Cancer Institute. “Even one dose of chemotherapy can impact fertility. The sooner we talk, the sooner they can understand their options and make decisions.”

Within the Breast Multi-modality Clinic at Lynn Cancer Institute, all patients of childbearing age are asked about their goals surrounding fertility and having children, said Darci McNally, the oncology-certified social worker who is director of Oncology Support Services and Community Outreach. “Allowing patients to be educated and make choices about their fertility before those decisions are taken away is critical,” she said.

Chemotherapy, surgery and radiation therapy can all diminish fertility, and certain medications can impact hormone levels or damage gametes directly, leading to temporary or permanent infertility.

Additionally, some cancer survivors, particularly those with certain types of breast cancer, are placed on medications they must take for five to 10 years to inhibit recurrence. Because there is a higher risk of injury to the developing fetus and a higher risk of miscarriage with many of these medications, women are advised not to get pregnant while taking these drugs.

“As a woman ages, her reproductive potential declines, so whenever these medications are prescribed for a number of years, it’s especially important to educate a patient about the long-term fertility impact their treatment could have,” Ms. Melik-Levine said.

Women who face fertility problems due to their cancer, have a variety of options they can discuss with their physicians or the experts at the oncofertility programs. Among them are egg and embryo cryopreservation and ovarian tissue freezing (often for pre-pubescent girls), as well as ovarian shielding to protect against radiation damage.

Other innovative techniques to preserve fertility are offered at only a few cancer centers. For example, earlier this year, Miami Cancer Institute became the first cancer center in the Southeast to perform a successful uterine transposition surgery. The young patient was a woman with colorectal cancer who required pelvic radiation. Surgeons temporarily moved her uterus and ovaries higher in the abdomen where they were sutured into place, out of the path of radiation.

There are also options for men going through cancer treatment to preserve fertility, such as sperm banking and testicular shielding, as well as still-experimental testicular tissue freezing, which is often the only option for prepubescent boys.

Of course, counseling and education also include discussion of the use of donor eggs and donor embryos, surrogacy and adoption. All consultations are individualized to the patient’s treatment, age, gender and family-planning goals.

Both Miami Cancer Institute and Lynn Cancer Institute can refer patients to reproductive specialists to pursue the option that is best for their circumstances. “Cancer is something that happens to a person and they have no control over it,” Ms. McNally said. “By getting them to fertility experts as quickly as possible, we are giving them some control back and hopefully increasing their chances of being able to start a family.”