Cancer is a challenging journey that often necessitates numerous life-altering decisions. For women of reproductive age, one of these critical decisions is understanding how cancer treatments might impact fertility and what can be done to preserve it. In this article we’ll explore this delicate intersection of oncology and reproductive health, and talk about the option of egg freezing.
The impact of cancer treatments on fertility
Cancer treatments, while lifesaving, can significantly affect fertility. These impacts can vary depending on the specific treatment, the dose, your age, and the area being treated.
- Chemotherapy medications, designed to target rapidly dividing cells, may inadvertently impact the eggs in the ovaries. This decrease can result in infertility, primary ovarian insufficiency, or a narrowed window of fertility, much like natural aging. Women over 35, having fewer eggs to start with, are more susceptible to this effect.
- Radiation therapy targeted at the pelvis or the entire abdomen can harm eggs and the uterus. The radiation can lead to scarring, or fibrosis, in the uterus, making it challenging for the uterus to accommodate a growing fetus. Consequently, women may face difficulties in conceiving or carrying a pregnancy to term, increasing the risk of miscarriage or premature labor.
- Treatments involving the brain, such as surgery or radiation, can affect the pituitary gland responsible for releasing hormones that stimulate egg maturation and ovulation. While the eggs in the ovaries are not directly damaged, the disruption in hormone regulation can affect fertility. However, hormone replacement medications may help restore fertility in these cases.
- Surgery involving one or both ovaries or the uterus can directly impact fertility. The degree of this impact would depend on the extent of surgical intervention.
If you are considering cancer treatment and are concerned about its potential impact on your fertility, it is important to discuss your concerns with your oncologist and/or a fertility doctor. They can provide you with information about the potential effects of cancer treatment on fertility and help you understand your options for preserving your fertility before treatment begins.
Egg freezing options
For those about to embark on cancer treatment, a few fertility preservation options can increase the chances of having biological children in the future.
Egg freezing (oocyte cryopreservation) is a process involving stimulating the ovaries with hormones to produce multiple eggs, which are then retrieved and frozen for future use. The entire process takes about two weeks from start to finish, but the start date depends on your menstrual cycle.
If you have a partner or choose to use donor sperm, the eggs can be fertilized before freezing, creating embryos for future implantation. The benefit of fertilizing the eggs immediately is that you will know how many embryos you have for future use.
Ovarian tissue freezing is a relatively new and experimental technique that involves surgically removing and freezing ovarian tissue, which contains thousands of immature eggs. This tissue can later be re-implanted to restore fertility or used to mature eggs in the laboratory. This may be an option for those who are not able to undergo egg freezing due the urgent need to begin cancer treatment.
To freeze or not to freeze
Making a choice on which fertility preservation option to pursue, if any, can be a difficult decision. A myriad of factors play into this decision, including your current health, age, cancer type, the proposed treatment regimen, personal circumstances, and future family plans.
Navigating a cancer diagnosis while also thinking about future fertility can be emotionally overwhelming. There are not only physical implications to consider, but also emotional, psychological, and social dimensions to this journey.
The chosen method must be compatible with your treatment plan and timing, as some methods require hormonal stimulation and time to mature and retrieve the eggs. A fertility doctor, alongside your oncology team, can provide the most accurate advice based on your unique situation.
It's important to seek emotional and mental health support during this challenging time. Reach out to your health care team, a mental health professional, supportive loved ones, or a support group of others going through a similar experience. It can be helpful to share your feelings, fears, and hopes, and to hear others' experiences and insights.
Financial considerations - how to pay for egg freezing
Another important aspect to consider is the cost of fertility preservation treatments. These procedures can be expensive, and not all are covered by insurance. Average egg freezing costs range from $10,000 - $20,000 for consultations, testing, ultrasounds, medications, and the egg retrieval, plus the ongoing cost of annual storage. But ultimately depends on the clinic you’re going to, where you are located, the medications you are prescribed (it differs based on your age and body), and where/how long you store the eggs.
There may be ways to lessen the financial burden, including:
Begin by thoroughly understanding your insurance coverage. Some health insurance plans provide partial or complete coverage for fertility preservation, especially in cases of medically necessary treatments such as cancer. Legislation in certain states mandates insurance coverage for fertility preservation for cancer patients.
As of the writing of this article, these states require health insurance plans to cover medically necessary fertility preservation:
- New Hampshire
- New Jersey
- New York
- Rhode Island
Reach out to your insurance provider to understand what is covered and what out-of-pocket costs you can anticipate.
Flexible Spending Account (FSA) or Health Savings Account (HSA)
If you have an FSA or HSA through your insurance plan, these funds can often be used to cover fertility preservation expenses. Check with your plan administrator to confirm what expenses qualify.
The IRS has traditionally considered fertility preservation treatments, like egg freezing, to be tax-deductible when they are deemed medically necessary. This typically refers to situations where a medical condition or treatment (such as chemotherapy for cancer) could cause infertility. You’ll want to talk to a tax professional about which egg freezing expenses you can deduct from your taxes.
Negotiating prices and shop around
Don't hesitate to discuss the costs with your fertility clinic. Some clinics may offer discounted rates or payment plans for individuals facing financial constraints. Get pricing from a few clinics to see your options.
There are a growing number of financing options, such as loans or payment plans, to help patients pay for egg freezing. These options allow you to spread the cost of the procedure over several months, making it more manageable. For example, Sunfish makes egg freezing (and fertility treatment in general) attainable for all types of families with low-interest loans or lines of credit.
Financial assistance programs and grants for cancer patients
Numerous organizations offer grants or financial aid to cancer patients seeking fertility preservation. Examples include the Livestrong Fertility Program, Team Maggie, Chick Mission, the SAMFund, The Ferring Heartbeat program, and Fertile Action. These organizations aim to alleviate the financial burden of fertility preservation and increase access to these vital services.
With the rising popularity of crowdfunding platforms, many people turn to their community, near and far, for financial support. Websites like GoFundMe can be used to raise funds for medical treatments.
Increasingly, employers are recognizing the importance of supporting their employees' reproductive health and are incorporating fertility benefits into their packages. Explore whether your employer offers any such benefits or whether they would consider adding them.
Options if you choose not to freeze your eggs
If you don’t freeze your eggs before cancer treatment, it's important to remember that does not mean the end of the road for parenthood. There are multiple paths available to build a family.
It may be possible to regain fertility naturally after cancer treatments, particularly if you are under 30 at the time of treatment. You’ll want to talk with your oncologist and a fertility doctor about when it would be safe to try for a pregnancy and the potential risks involved.
For women whose ovarian reserve has been significantly impacted, the use of donor eggs can be a great option. In this process, eggs from a donor are fertilized with your partner's sperm (or donor sperm), and the resulting embryos are implanted in your uterus. This path allows you to experience pregnancy and childbirth.
If the uterus has been damaged by radiation or surgery, or if pregnancy poses a health risk, gestational surrogacy might be an option. In this case, an embryo (created with your egg or a donor egg and your partner's or a donor's sperm) is carried by a gestational carrier.
Finally, adoption remains a heartfelt path to parenthood for many individuals and couples. Adopting a child can be a fulfilling choice that meets the deep desire to raise and nurture a child.
Living with the aftermath of a cancer diagnosis can be challenging, particularly when it affects your family planning. However, remember that numerous avenues to parenthood remain open, and while they may not be the paths you initially envisioned, they can be equally rewarding and enriching. Your dream of becoming a parent can still be a reality; it might just involve a different route than you originally planned.
Summing it up
Navigating the landscape of cancer and fertility can be laden with emotional and medical complexities. However, armed with knowledge about potential impacts and available options, you can make an informed decision that aligns with your future family-building aspirations. Your oncology and fertility teams can provide guidance and support, helping you weave your way through this intricate journey and minimizing future regrets. In the end, the goal is to optimize not just survival, but also quality of life and future dreams.