For people who hope to have children of their own, a cancer diagnosis can derail those plans. However, thanks to oncofertility experts, who serve as a bridge between oncology and reproductive medicine, patients have several reproductive options to explore.
“While there are many paths to parenthood — such as foster care, adoption and embryo donation — my goal is to try to expand those options as much as possible to include having children with your own eggs or your own sperm,” says Laurie McKenzie, M.D., associate professor in Gynecologic Oncology and Reproductive Medicine.
McKenzie’s mission to empower patients to make the best decisions for their future family is both professional and personal. She and her husband, a leukemia survivor, underwent fertility preservation when he was diagnosed with cancer more than 20 years ago.
“If it weren’t for fertility preservation, we wouldn't have the family that we have,” she says. “I certainly understand how important this is for patients.”
Here, McKenzie discusses why it’s important to discuss your fertility early and what to expect during your first meeting with an oncofertility specialist.
Why is it important to talk about fertility preservation before treatment?
Patients typically have more future family building options in the future if I meet with them before they start cancer treatment. For example, if chemotherapy is part of their cancer treatment plan, egg freezing and sperm banking is contraindicated during most chemotherapy regimens. This means that for the vast majority of patients, it’s too late to cryopreserve eggs, sperm or embryos once they've already started chemotherapy.
What questions will patients be asked when they first meet with an oncofertility specialist?
One of the most important things for me to get a sense of is what their ideal goal is in terms of what their future family looks like. It's also helpful that they have some knowledge of their family's reproductive history. This includes whether anyone in their immediate family had an issue with infertility and whether any known genetic disorders run in their family.
We’ll also conduct a baseline fertility assessment to understand the patient’s reproductive history and health history. Have they attempted pregnancy before? Have they been diagnosed with infertility? Do they have regular menses? If I’m meeting with a male patient, has he led to a pregnancy before?
What should patients ask their oncofertility specialist during their initial appointment?
There are several questions I recommend asking. These include:
- How likely is my cancer treatment to impact my fertility?
- How would we know what is a safe time for me to attempt to have a child in the future?
- Is it safe for me to have a child in the future?
- Are there increased risks of health problems in children born from cancer survivors, specifically those who have the type of cancer I have?
- Are there steps I can take to protect my fertility during cancer treatment?
What fertility testing is available before and after cancer treatment?
For women, my recommendation is to consider:
- a fertility blood test called an Anti-Mullerian Hormone test (AMH for short) and
- a baseline ultrasound that counts the resting number of follicles in your ovaries (called an antral follicle count).
These two tests combined can help give me a snapshot of someone’s fertility potential and provide a comparison after they've completed cancer treatment.
For men, I recommend conducting a semen analysis at the time of sperm cryopreservation. Once they bank sperm, we go over the results of their semen analysis and the number of vials of sperm that they have frozen to discuss how that sperm can be used in the future.
If chemotherapy is part of the cancer treatment plan, we typically repeat those tests every one to two years after their cancer treatment is completed. If somebody has not yet completed childbearing, we'll track those fertility metrics to see if there is a change, if there has been recovery of their fertility function or if their cancer treatment has impacted their fertility.
What happens after the initial meeting with an oncofertility specialist?
For women, I recommend a follow up visit 12 to 18 months after they finish chemotherapy. Then, I track their fertility and discuss their reproductive goals. Regardless of whether they have a partner or not, I want to know what they're thinking in terms of long-term fertility plans and timing.
Once men complete their cancer treatments, we recommend repeating a semen analysis about 12 to 18 months afterward to see whether they have viable sperm. That would help determine if they would be able to conceive spontaneously or if they would need to use that cryopreserved sperm.
If you haven't finished building a family or if having children is very important to you, talk to your MD Anderson oncologist about getting referred to us as soon as possible for us to discuss your fertility preservation options.
We are here to support you. We don't want somebody to come to our appointments with any trepidation or anxiety. Our goal is for this to be a very positive, empowering experience.
Request an appointment online at MD Anderson or by calling 1-877-632-6789.