Planning Family

The risk of infertility after cancer treatment is a shock to many young couples, but there is still plenty of hope

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Christy Soholt and her husband Trevor had just started talking seriously about having a baby when Christy noticed a lump in her breast. At 28, the Edmonton resident wasn’t concerned; as her doctor said, it was probably a cyst. Still, Christy and Trevor put their parenting plans on hold for a couple of weeks while she waited for the lump to disappear. Instead, there was a change of plans.


Illustration by Heff O’Reilly

Christy’s doctor decided on a biopsy and Christy was diagnosed with breast cancer. The next day she was in a surgeon’s office.

“He talked about my options for lumpectomy and mastectomy (removing the lump or the entire breast), then went on to say I would need chemotherapy, and that treatment would likely make me sterile,” says Christy. The news was shocking. Like many people, the Soholts had no idea that cancer treatment could have this particular life-altering impact.

As Christy soon learned, her surgeon was misinformed; not all women treated for cancer end up infertile. “The rate of infertility varies greatly depending on age, the kind of chemotherapy agent and other factors in the person’s medical history,” explains Dr. Shu Foong, a physician for the Regional Fertility Program in Calgary. “But there is, unfortunately, no one test that can accurately predict who will or will not have trouble with infertility following chemotherapy.”

Chemotherapy and radiation can destroy rapidly dividing cells, and that includes the eggs that a woman is born with. Treatment can put a woman into early menopause, making her unable to get pregnant without medical intervention. If only partial destruction of eggs occurs, her periods may resume, but fertility may still be affected. Eggs can be badly damaged and, because there may be fewer eggs left, she may go into menopause earlier. It means that women who are diagnosed with cancer and want to preserve their fertility need to consider their options at the outset.

Just days after the diagnosis, Christy and Trevor travelled to the Regional Fertility Program clinic in Calgary to find out what they could do to preserve their dreams of having a baby. There they learned that their best option for a biological child was in vitro fertilization (IVF), in which a woman’s eggs are harvested and fertilized outside her body, and the resulting embryos are frozen, saved for implantation after treatment is finished.

“That’s your gold standard,” says Dr. Foong. “It’s important for people to realize that if you try to preserve fertility, you want to go with the best chances of success.”

But the cost is high. Depending on whether you have coverage, IVF can cost approximately $10,000 to $12,000. The success rates for younger women like Christy are 50 per cent or higher.

The only other option is to freeze (or vitrify) eggs. Women go through the same process of hormone injection and egg harvesting, and then the unfertilized eggs are frozen. At a later date, the eggs are thawed and fertilized, and the embryos are placed into the uterus when required. The process, says Dr. Foong, is still experimental and doesn’t work as well as freezing embryos.

Christy and Trevor decided to forgo freezing embryos or eggs for a number of reasons. The cost was high for the young couple and they knew that Christy could come through treatment with her fertility intact. They would also have to travel to Calgary to begin hormone injections the day after Christy had surgery.

“At this point in my cancer diagnosis, I didn’t know if my tumour was hormone-receptor positive,” she says. Injecting hormones could spur on the growth of such cancer. “We also didn’t think driving three-and-a-half hours the day after my first-ever surgery was a great idea,” says Christy. Ultimately, she explains, they realized they needed to focus on the present, on taking care of Christy rather than on what might happen in the future.

It’s a decision that Trevor says he might not have made today. He describes IVF as “another tool,” one that could extend the options of couples seeking to preserve fertility.

Christy and Trevor may have had to delay their plan for a family, but the plan hasn’t changed. Christy remains hopeful in spite of an insensitive comment from a doctor at a fertility clinic in Edmonton who Christy saw to find out if there was anything she could do to increase the likelihood of conception.

“I had gone through genetic testing because I got breast cancer so young,” says Christy. She carries a genetic mutation that increases the risk of both breast cancer and ovarian cancer. “The doctor at the fertility clinic said that I should be grateful that I couldn’t have children because I wouldn’t pass on the mutation and have to live with that guilt.”

As a communications associate at the Alberta Cancer Foundation, Christy doesn’t agree. Because of her job, she understands that the knowledge about cancer and techniques for preventing and treating it are evolving constantly. “By the time my children are my age, we’ll have made a lot of progress,” she says.

The couple has also explored international and domestic adoption. After an eight-month application process, they have put their names on a waiting list for the private adoption of a newborn. They’ve been on the list for a year and will continue trying to conceive.

“I’m so determined now that this will happen for us,” says Christy, of her desire to have a family one way or another. “Before, we thought maybe kids wouldn’t be a thing for us. Now we are so aware of how precious life is and how much we do want a family.”

Advice from those in the know

Talk to your doctor early. This gives you more time to gather information and make a decision.

Look for accurate information. The medical community is becoming more informed thanks to doctors like Dr. Foong, who lectures and writes on this subject, but as Christy’s experience shows, there is still misinformation out there. Websites like fertilehope.org and fertile-future.com are good places to start.

Focus on today. If you’re in treatment, you need to take care of yourself. Remember too, that science is always advancing. For example, ovarian tissue preservation may someday allow doctors to preserve a part of the ovary to allow for transplantation at a later date.

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