My mother is a 28-year breast cancer survivor. Her diagnosis had so many effects, some of which were positive, including my decision to become a physician focusing on women’s health. I now specialize in Reproductive Endocrinology and Infertility, which includes fertility preservation for those facing cancer. This is important for survivors, as the ability to reclaim a normal life - including the ability to have a family - is central to recovery. The problem is, Dr. Google doesn’t always get things quite right, and women often need better advice about what to do with a new diagnosis and how things should be addressed several years down the road than just relying on what they read on the internet.
If you’ve been recently diagnosed, the number one thing you should do is coordinate your care with your clinicians. Up to 25-40% of women diagnosed with cancer in their reproductive years participate in treatment differently (without telling their physicians) out of fears of how therapy will affect their fertility. Nothing is more important than your survival, and fertility specialists can work with your oncology team to help find the right balance. Women should know there are minimalist options such as a one-time shot (Lupron); advanced options (banking of eggs and embryos); and down-the-road treatments (from regular conception to donor egg and adoption). The best solution is what is right for you, and communication helps everyone find the healthful balances.
If you are a several year survivor, way to go! When it comes to fertility, beyond deciding your goals (how many children, when), the most important thing to understand is how well your ovaries are functioning. Depending on how many rounds of chemotherapy have taken place, and how alkylating it was, there can be a lot of variation in “ovarian reserve.” Ovarian reserve testing asks if one’s biologic age is 30, are the eggs acting more as though they are age 25, or are they more age 40? This evaluation is important, as many women are mistakenly told if they are having menstrual cycles, their ovaries are fine. This is not always true, as we often see chemotherapy aging the ovaries by 10 years. For example, if you are diagnosed at 25, have chemotherapy, and wait until you are five years cancer-free, the ovaries may act more as though they are 40, even though someone is technically only age 30. Pregnancies can still happen, but one needs to be a bit more assertive. However, if one is diagnosed at 30, waits until 35, and has eggs functioning as though one were 45, this is harder, even though one may still be having regular cycles, as many women in their late 40s do. This is why we often try to bank eggs or embryos in advance, but still have options even when this hasn’t been done.
Every woman is different, as is every experience. You are not alone, and your clinicians have helped others navigate these waters many times in the past. Knowledge is power and those that receive support through a larger community (including through this blog) tend to do better than those that go it alone. Let us help you!