Fertility

Some cancer treatments, including radiation to the testes or ovaries, surgery to the reproductive organs and alkylator drugs, may cause fertility problems in both men and women. (See Late Effects Assessment.) Other factors that may affect a childhood cancer survivor's fertility include:

Type and location of cancer.
Age and developmental age at time of diagnosis.
Gender.
Types and dosage of drugs.
Radiation to the brain affects organs and glands that require stimulation to function and produce hormones.

Because fertility is a sensitive and emotional topic, it may be difficult to discuss with your partner. The following material is meant to provide you with information and options. Modern medicine continues to make advances both in the area of infertility and the area of minimizing the late effects of cancer treatment related to fertility. (See Cancer Resources for updated fertility sites.) Please discuss any concerns, and options with your doctor.

What is infertility?

Infertility is the inability to start or maintain a pregnancy. Some cancer treatments:

Cause infertility.
May increase the difficulty of conception.
Make maintaining a pregnancy more difficult.

If you are female and just beginning cancer treatment, Lindsay Nohr, Founder of Fertile Hope, has written some helpful questions (listed below) you may wish to ask your medical team. If you have completed treatment, these questions may help you gather information regarding your current and future fertility.

Will my treatment have any short- or long-term side effects on my reproductive system?
Is infertility a possible side effect?
Are there alternative treatments that will result in less damage to my reproductive system?
What are my fertility-preservation options before, during and after treatment?
Would any of these options make my cancer treatment less effective?
After treatment, will I experience premature menopause?
If I become menopausal after treatment, is this change permanent or temporary?
If I become infertile after treatment, what are my options for becoming a parent?
How long should I wait after treatment before trying to conceive?
Can you refer me to a infertility specialist?

What are my choices if I believe I am infertile?

Talk with Your Physician
If you are concerned about infertility, talk with your doctor about the type of cancer and treatment you had as a child. Treatments once thought to cause infertility have actually not affected fertility. This information may affect your decisions regarding birth control. You may also consider consulting with an infertility specialist. Many options are available to infertile couples, including fertility-cycle hormonal enhancement, donor insemination, donor eggs, in vitro fertilization and surrogacy. For more information on parenthood options, visit Fertile Hope. Fertile Hope is an organization dedicated to helping cancer patients faced with infertility. The Web site details the actual procedures and costs associated with each option.

Adoption
Many infertile couples choose adoption rather than infertility treatments, or they decide to adopt after infertility treatments have failed. If you are considering adoption, you have many options from which to choose, including domestic parental placement, domestic waiting child/foster care adoption and international adoptions. Each has its own benefits and risks. You may want to begin your research at the local library. Several factors to consider prior to adoption are cost, ethnic heritage, the age of the child you wish to adopt, preparation in dealing with a child who has been abused or neglected, and flexibility in traveling at a moment's notice. For further answers to adoption questions, visit www.forumadoption.com.

Remain Childless
Some infertile couples chose to remain childless. This can be a rewarding option for couples who have dealt with their infertility and have decided to fulfill their lives in other ways. This may or may not include having children into your life. Perhaps you might choose to volunteer at a school, camp or nonprofit organization that works with children. Or you can take an active role in the lives of children that you are close to, including nieces, nephews and children of friends.

Do health-insurance plans cover infertility treatments?

The degree to which infertility services is covered depends on where you live and the type of insurance plan you have. More than a dozen states currently have laws that require insurers to either cover or offer some form of infertility diagnosis and treatment. The laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office or visit www.resolve.org. To learn about pending insurance legislation in your state, please contact your state representative (see Advocacy). Whether or not you live in a state with laws requiring insurance coverage for infertility treatment, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides.

What impact does infertility have on psychological well-being?

Infertility, overwhelming medical decisions and the uncertainties infertility can generate, often combine to create one of the most distressing life crises that a couple can experience. The long-term inability to conceive a child can evoke significant feelings of loss. If your find yourself feeling anxious, depressed, out of control or isolated, you are not alone. However, if these feelings persist, professional intervention may help you cope.

How I do I know if psychological counseling would be beneficial?

Everyone has feelings and emotional ups and downs as they pursue infertility treatment. Feeling overwhelmed at times is a perfectly normal response. However, if you experience any of the following symptoms for a prolonged period, you may benefit from working with a mental health professional:

Loss of interest in usual activities.
Persistent sadness or depression.
Strained interpersonal relationships.
Difficulty thinking of anything other than your infertility.
High level of anxiety.
Diminished ability to complete tasks.
Difficulty concentrating.
Change in sleep patterns.
Change in appetite or weight.
Increased use of drugs or alcohol.
Thoughts about death or suicide.
Social isolation.
Persistent feelings of pessimism, guilt or worthlessness.
Persistent feelings of anger or bitterness.

There are times during infertility treatment when discussion with a mental health professional about infertility options and your feelings can clarify and aid your decision-making. For example, consultation with a mental health professional may be helpful to you and your partner if you are:

At a treatment crossroads.
Deciding among alternate treatment options.
Exploring other family-building options.
Considering third-party assistance.
Having difficulty communicating with your partner, or if you and your partner have different views about which direction to take.

How can psychological treatment help me and my partner cope with infertility?

Mental health professionals with experience in infertility treatment can help a great deal. Their primary goal is to help individuals and couples learn to cope with the physical and emotional changes associated with infertility, as well as with the painful and intrusive medical procedures that are often part of its treatment. For some, the focus of therapy may be on how to deal with a partner's response. For others, it may be on how to choose the right medical treatment or begin exploring other family-building options. For still others, it may be on how to control stress, anxiety, or depression. By teaching clients problem-solving strategies in a supportive environment, mental health professionals help them work through grief, fear and other emotions, leading to a positive resolution of their infertility issues. A good therapist can also help you strengthen current positive coping skills and develop new ones, and improve communication with others. For many, the crisis of infertility eventually proves to be an opportunity for life-enhancing personal growth.

Available Resources:

(Some of the above material reprinted with permission from the American Society of Reproductive Medicine.)