How Cancer Patients Can Preserve Their Fertility

When Annie Dauer's oncologist told her she'd need a stem-cell transplant to cure her non-Hodgkin's lymphoma, Dauer's first thought wasn't about death but about life. "I asked what would happen to my fertility," she says. Her oncologist dismissed the question: " 'Honey, you're fighting for your life; forget the fertility at this point,' she told me." But Dauer, then 30 and newly married, pressed the subject until the oncologist referred her to a fertility specialist. Since Dauer's chemotherapy regimen would most likely destroy her body's egg supply, the specialist, in an experimental procedure, removed one of her ovaries, froze it and reimplanted it when Dauer recovered. Three years later, Dauer, now cancer-free, and her husband, Greg, have a 2-year-old daughter, Sienna, and a second baby on the way.

Welcome to the burgeoning world of oncofertility. As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties—oncology and assisted reproduction—to come together. "The narrative of cancer is no longer that it's a death sentence; it's a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle," says Teresa Woodruff of Northwestern University's Feinberg School of Medicine, who last fall received a first-of-its-kind $21 million NIH grant to develop ways of protecting cancer patients' reproductive health.

Of the 125,000 people under the age of 45 who are diagnosed with cancer each year, roughly half will receive treatments that will affect their fertility. The cancers that most commonly strike the young—leukemias, lymphomas and breast cancers—require some of the most toxic forms of chemotherapy, which target rapidly growing and fragile cells like hair follicles, sperm and eggs. The good news: patients who would like to become parents have a growing array of options. Men are benefiting from a procedure that allows urologists to find a single live sperm to bank, which can then be used in an in vitro fertilization method that requires just one sperm. Women can freeze eggs or ovarian tissue, though success rates are still low. Those with partners (or donor sperm) can freeze embryos, the procedure with the best track record, though, like egg freezing, it's available only to patients who have two to six weeks before starting treatment. On the horizon are less toxic chemotherapy agents as well as methods of shielding eggs and sperm from harm.

Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility. Advocacy groups like Fertile Hope, which educate cancer patients about assisted reproduction, deserve credit for spreading the word. "It's being talked about more," says Nancy Lin, an oncologist at Boston's Dana-Farber Cancer Institute. "There's a growing awareness among doctors, and patients are more proactive."

Two years after Dauer completed her cancer treatment, her doctor, Kutluk Oktay, founder of New York City's Institute for Fertility Preservation, sutured a one-inch strip of ovary, containing tens of thousands of microscopic eggs, under the skin just below Dauer's belly button. "Every month, I would feel little eggs, sometimes pea-sized, sometimes as big as a quarter," says Dauer. Normally, Oktay, who pioneered this procedure, would have harvested mature eggs, fertilized them with Greg's sperm and implanted them into Dauer's uterus. But in an unexpected development, Dauer became pregnant naturally; somehow, the implanted ovary jump-started her remaining, inactive ovary and she began to ovulate. Oktay is at a loss for an explanation. "The healthy ovary may contain signals or hormones that may enable the [dormant] ovary to regenerate eggs," says Oktay. "That's the theory, other than a miracle."

When cancer's involved, even joy can be shadowed by uncertainty. Ronny Villarreal, 32, survived breast cancer, then, with her oncologist's OK, stopped a common hormone-suppressing treatment early in order to conceive. Unfortunately, the cancer recurred during her second trimester of pregnancy. Villarreal's daughter, Maddy Hunt, now 4 months old, is healthy, but Villarreal is facing more chemotherapy and a cloudy prognosis. "We are trying our hardest to stay positive," she says. "We have so much to live for." More, certainly, than if she never had the chance to get pregnant at all.

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