Reproductive Health and Fertility Options Before and After a Cancer Diagnosis

February 15, 2020
Featuring Kristin N. Smith, Program Manager for Fertility Preservation at Northwestern Medicine

First Speaker

Kristen Smith is the Program Manager for Fertility Preservation, consults with all young, newly diagnosed oncology patients at Northwestern’s Lurie Cancer Center to help each patient understand their individual fertility risk associated with treatment as well as options for fertility preservation. She works extensively with young adult oncology survivors to help each patient explore their unique family building options and reproductive health post treatment.  Kristin helps run the National Physician’s Cooperative of the Oncofertility Consortium by providing support across the country to providers who participate in national fertility preservation studies and answers the national fertility hotline to triage patients for fertility preservation across the country.

Oncolofertility Consortium- founded by Dr. Teresa Woodruff- a global initiative-http://oncofertility.northwestern.edu/

To find a clinic near you- https://oncofertility.northwestern.edu/find-a-clinic-or-center

Male Fertility
  • Sperm cells can be damaged during cancer treatment from chemotherapy, radiation, or from surgical removal of testicles
  • The process for sperm banking involves seeing an infectious disease doctor, a urologist for testing, and providing a sample for sperm count/viability review.  If your sperm is viable, they will freeze it in as many vials as possible.
  • If you have difficulty providing a sample, there is a surgical procedure that could help them try to get a sample.
  • If a patient is a child, there is an experimental protocol that can be done, taking a testicular wedge resection surgically to try to be able to use later in life to repopulate his sperm.
  • You can see a reproductive urologist even after treatment that can make recommendations for your specific case.  If your sample is void of sperm, they can try surgery to extract it. If they still cannot get sperm, they might recommend sperm donation or adoption.
Female Fertility
  • Female fertility issues are more complex.  Most woman’s eggs are almost gone by their early 40’s and the one’s that are left might not be as genetically viable.
  • Egg & Embryo Freezing require you to see an endocrinologist, giving yourself injections for 2 weeks to stimulate optimal egg release, egg retrieval under sedation, and if you already have sperm, they can create the embryo and freeze it.
  • If the patient is pediatric, they can freeze cortical strips of ovarian tissue as eggs are not mature enough yet.  They can transplant this back into the patient later. This has created 130 live births.
  • There are concerns for reseeding cancer that need to be considered.
  • Invitro follicular maturation is being studied to minimize this risk.
  • Giving Lupron medications before treatment may create less damage on ovaries and take away periods during treatment.
  • If you want to discuss fertility issues, discuss this with your gynecologist who can refer you to an endocrinologist.
  • Sometimes, eggs can even be saved after treatment.
  • Livestrong has been a great resource for financial assistance for fertility medications and for connecting people to reputable resources. https://www.livestrong.org/we-can-help/livestrong-fertility
  • Kristin also recommends the Alliance for Fertility Preservation.  They are working to get bills passed to cover oncofertility medications. https://www.allianceforfertilitypreservation.org/

Megan Connolly is a two-time cancer survivor, of Hodgkin’s Lymphoma. She was diagnosed at 19 years old and relapsed at 21. Megan had to undergo chemotherapy, total body radiation and a stem-cell transplant. A result of her aggressive treatment, Megan learned that she was at an increased risk of infertility due to the toxicity of her treatment. As a young woman she always knew she wanted to be a mother but had no idea that the treatment she needed to save her life, could take away the opportunity to have a biological child. Megan was fortunate enough to be referred to Kristin Smith and the Oncofertility team at Northwestern Medicine, and was able to harvest her eggs prior to treatment. Livestrong assisted her with medications and connections for egg harvesting.    After two weeks of injections, she was able to harvest 7 eggs. She is so glad she was able to do this as one year after her transplant, Megan received the diagnosis of premature ovarian failure, at the young age of 22. It was in that heartbreaking moment, that Megan knew how fortunate she was to have been able to preserve her eggs, which inspired her to help others in similar situations.

She testified in the Illinois House and Senate to help pass Illinois HB2617, which mandates insurance companies to cover fertility preservation for patients who are at an increased risk of infertility due to a medical condition/treatment. Megan is also active in the young adult cancer community with organizations like Immerman Angels.

Questions
  1. How do I know if my eggs are damaged?  See a reproductive endocrinologist. Your ovaries may have been aged but treatment doesn’t always mean damage to the eggs.
  2. Is there financial help for a surrogate?  Kristin recommending using someone you know if possible.  A known surrogate costs 40-60K in legal fees, medical insurance, etc.  An unknown surrogate is usually around 80-100K. You can reach out to Livestrong to see if there is any known assistance, but most people try to get help from fundraising or medical loans since there is not really support out there for surrogates.
  3. How long does it take periods to re-establish after treatment with Lupron?  It usually takes 1-3 months.
  4. How long should I wait after transplant before trying to conceive?  First ask your doctor for his blessing as each care plan is different.  The usual wait time is around 18-24 months though.
  5. My son had a transplant in November, is it possible he will ever conceive naturally?  Sperm can still be affected by chemotherapy for up to a year which can cause infertility, birth defects, or miscarriage.  Talk to your doctor, but it is best to wait at least one year after chemo before trying to conceive naturally.
  6. What helped you cope during all of this Megan?  My will to survive, support, I recommend people reach out to others who know what this is like, getting support post treatment- for her support groups, giving back to other cancer patients, advocating for other cancer patients,
  7. Recommendations to make change for coverage in your area.  Connect with team, network with organizations, and those in the legal field to try to make change in legislation.  Joyce Reineke, lawyer/cancer survivor/advocate from Alliance for Fertility Preservation was a great support.