What Cancer Patients Should Know About Preserving Fertility — and Hope
Steps taken before starting cancer treatment can preserve a patient’s ability to have children. A Michigan Medicine doctor explains.
Ask Molly Moravek, M.D., why she pursued a career in fertility preservation for cancer patients, and she’ll tell you that it’s because her heart breaks every time she sees a patient who has had her fertility taken from her.
“It’s the patient who never was told that her cancer treatment was going to affect her fertility, or who is here once she’s already started treatment and I can’t offer much,” says Moravek. “Or maybe someone mentioned it but didn’t really emphasize it for her, and she doesn’t really remember it. And then I’m the one who has to tell her that her ovaries are no longer working properly, and she will probably never be able to use them to have a baby.”
Chemotherapy, radiation and even some immunotherapies can interfere with a patient’s reproductive system and affect his or her ability to have children. The option to preserve eggs or sperm prior to treatment has long been available, but it is often not communicated or recommended to patients. Many patients don’t realize that they have options, or they find out too late.
Moravek wants to change that.
To that end, she built a program in partnership with Michigan Medicine’s Center for Reproductive Medicine and Comprehensive Cancer Center that works with patients facing treatment and their oncologists to preserve the patients’ opportunity to have children once they are healthy.
Moravek spoke recently about cancer fertility preservation, and what makes U-M’s offerings unique.
Who is cancer fertility preservation for?
Moravek: Women of reproductive age who are getting ready to undergo chemotherapy, radiation or removal of their ovaries. We can freeze their eggs, or if they have a partner, we can freeze embryos. We also have medical options to offer them, although they are likely not as effective.
Similarly, for men who are undergoing chemotherapy or radiation or who need to have their testes removed, we can freeze their sperm or make embryos with their partner.
We see a lot of women with breast cancer because those are often women of reproductive age.
What does cancer fertility preservation involve?
Moravek: For women, probably the quickest and easiest option is an injection that shuts down the ovaries; the thought being that chemotherapy attacks rapidly dividing cells, and if we can make the ovary quiet, then maybe it won’t be as susceptible to chemotherapy. This option is still considered experimental.
If we have a little more time, I can freeze eggs or embryos in as little as two weeks. Then we can get them right back to their oncologist, and they can start chemotherapy the next day.
We’ve done a lot of research now that suggests there’s no increased recurrence or mortality in the patients who took that two-week delay versus those who didn’t.
For men, preserving sperm is obviously easier. The problem, though, is that a lot of men with cancer will have decreased sperm count or difficulty producing a sample. We have excellent reproductive urologists on our team who can help with that. They can also counsel those patients on how many samples they should freeze given this amount of sperm, rather than just freezing a single sample and saying “good luck later.”
How is Michigan’s program different from other fertility programs?
Moravek: We’re not just a fertility clinic that freezes eggs and embryos and sperm — any clinic can do that. We are a comprehensive program with doctors trained in the different chemotherapies and their risk profiles, nurses comfortable with the accelerated schedule of a cancer patient, fertility-trained mental health professionals and a fertility preservation coordinator.
We’re really focused on making this as patient-friendly as possible, and a big part of that is our coordinator. She communicates with the patient’s oncologist and helps incorporate fertility preservation into their cancer treatment plan. She also helps patients schedule appointments and figure out all of their prescriptions and insurance coverage. We don’t want fertility preservation to be one more hard thing this patient has to do.
Why is it important to offer fertility preservation to patients facing cancer treatment?
Moravek: I think it’s important because a lot of patients are shocked by the loss of fertility at the end of their treatment, and there are multiple studies showing this is one of the most pervasive regrets for these patients.
They either feel guilty that they didn’t do it, or they feel angry that nobody talked to them about it. I think that for many young women, it’s a huge personal loss to suddenly feel like you can’t procreate.
Studies show that even just the fertility counseling matters. So for the women who choose not to preserve their fertility, the chance to make an informed, educated decision matters to these patients when you ask them again after their cancer treatment.
I see fertility as a health issue, not a luxury. I think everyone should have the right to have a baby. If we know we are doing something that has a high likelihood of taking that away from them and we can intervene, why wouldn’t we?
When you’re going through cancer treatment, having hope is important. This is what I tell people. Your oncologist sent you to me because we’re talking about life after cancer treatment. That’s a good thing. If they didn’t think we could be talking about your life after cancer, they wouldn’t be sending you. Let’s talk about the good things to come.