Wednesday, September 4, 2013
Chemotherapy and radiation can damage a cancer patient's fertility. But there are steps patients can take to preserve their chances.
SAN DIEGO People with cancer face a lot of uncertainty. That’s especially true for patients of reproductive age who’d like to have kids someday.
When she tells patients the particulars of their disease and how to treat it, they’re often in shock.
"And oftentimes patients, when faced with the initial diagnosis, and having to go through this life-changing decision of chemotherapy and learning about their cancer, fertility isn’t always at the top of their mind," Ku said.
But for patients under the age of 44, fertility is definitely something that needs to be considered.
Certain cancer treatments can damage a patient’s fertility, or even cause sterility.
"So any time a patient’s undergoing chemo, chemotherapy, I do want to discuss with them the potential impact on their fertility," Ku explained. "Certainly there are some regimens that have more of an impact than others, would be one thing, so the intensity of the chemotherapy, the type of agents used in that chemotherapy."
Doctors estimate this year, about 1.7 million Americans will be newly diagnosed with cancer. The vast majority of them will be over 55.
Even so during a recent four-year period, the National Cancer Institute says nearly nine percent of cancer patients were under the age of 44.
Christina Montana, who lives in Lemon Grove, was diagnosed with Hodgkin’s Lymphoma when she was 14. That’s a cancer that affects the lymphatic system.
Shortly after she got her diagnosis two years ago, Montana was told the radiation and chemotherapy she’d receive could damage her fertility. So Montana consulted with a fertility specialist.
"My doctor actually recommended it," Montana recalled, "‘cause they told me everything that could possibly happen. They said it was possible that I couldn’t have kids on my own after it. It was just a possibility, but I still thought I should do it."
Montana remembers her first visit with the fertility doctor was strange.
"When I first met with her, it was a little awkward for me, ‘cause I never thought I’d have to do that. And first they did kind of like, I think it was an ultrasound of my ovaries. And they put this gel on me, it was weird," she said.
Montana got a series of injections to stimulate her ovaries. Then, some of her eggs were extracted and frozen.
Dr. Catherine Adams is laboratory director at the Reproductive Sciences Center in La Jolla. It’s one of the region’s many fertility clinics.
"So this is a tank of liquid nitrogen. You have canisters which contain patients’ specimens stored in vials, frozen, minus 196 degrees centigrade," Adams explained, as she pointed to a large, silver container.
Eggs, sperm and even embryos are preserved in a frozen state for future use.
Women’s eggs are extracted in a different part of the lab, and placed in a special incubator.
"It’s a mobile chamber, which keeps the eggs warm," Dr. Adams said in front of the incubator. "We have gas, CO 2 gas flowing in, so we can keep a very stable environment, protecting the eggs."
Clinic director, Dr. Samuel Wood, said fertility preservation for people with cancer is a relatively new field.
"It’s only really come into its own since 2006," Wood explained. "And I think we’re all still trying to figure out exactly how all the pieces fit in. But it’s definitely multi-disciplinary; many different physicians need to get involved. They need to get involved early, and when they’ve done so, we’ve seen outstanding results."
Wood said the success rate for women who go through fertility treatment depends on their age at the time their eggs are removed. He says success rates of 60 to 80 percent are possible.
But Wood adds despite these results, only about five percent of female cancer patients take advantage of fertility treatment.
Part of the reason may be the price tag: harvesting eggs can cost up to $15,000. And most insurance companies won’t cover it.
But there’s another factor. Studies show only about half of all oncologists tell patients that cancer treatment could affect their ability to have kids.
Christina Montana thinks that’s a shame.
"I just…like even thinking about it, I just feel terrible for the people who didn’t know. I’m just like, I wish they had the option," Montana said.