Preserving Fertility Before Treatment

When I learned six years ago that I carry a genetic mutation called CDH1, my initial response was anger. I had just gotten married, and my husband and I were looking forward to starting a family. That discovery put a serious monkey wrench in our plans.

But the mutation was bad news not only because it significantly increased my own risk of developing breast and stomach cancers. It also meant that any children we might have could share in this terrible legacy. That thought was really hard to accept.

My risk of developing stomach cancer was so high that the recommended course of action was to have my stomach surgically removed, even if I didn’t have cancer yet. I put it off at first, but got so tired of worrying about it that I finally had it done at MD Anderson in 2017.

Today, I’m really glad that I did. Because the pathology report showed early cancer cells were already present in my stomach. And having the surgery first gave me time to learn about IVF with PGD-M. That has enabled my husband and me to protect both our unborn son and any future children we might have from CDH1 — and to give my family some peace of mind.

Exploring our options leads to IVF with PGD-M

My surgeon, Dr. Paul Mansfield, wanted to make sure I’d completely recovered from my gastrectomy before trying to conceive. So, I waited about 18 months to reach out to MD Anderson’s Oncofertility Consult Service.

There, I met with Dr. Terri Woodard, who told me about the various options available to start a family. One was IVF with PGD-M (in-vitro fertilization with preimplantation genetic testing for monogenic or single-gene defects). I had heard of it before, but didn’t really know much about it.

It turns out that PGD-M allows embryos created through IVF to be tested for specific genetic conditions prior to transfer to a uterus. That reduces the chances of passing on defective genes. If we did it, there was at least a chance we could eliminate this threat — both in our children and in generations to come.

Elated to be pregnant with our first child

You might think the decision to proceed with IVF with PGD-M was an easy one. But I had some misgivings about it initially. So, my husband and I prayed about it and talked it over with our family and friends. Ultimately, we decided this was the best way for us to have children.

Once we’d made our decision, we contacted a fertility center close to our home in Michigan. We started working closely with a reproductive endocrinologist, a genetic counselor and various reproductive lab technicians in early 2019. They guided us through the process of egg retrieval and transfer.

First, we completed two rounds of egg retrieval. Then, each egg was fertilized with my husband’s sperm and given time to grow in the lab. Embryos that survived the first five or six days were frozen, and a few of their cells were extracted and sent to a lab in Chicago. Technicians there then tested the cells, looking specifically for the CDH1 mutation and any other chromosomal defects.

Ultimately, three frozen embryos were deemed good candidates for transfer. We transferred the first one on Feb. 25, 2020, and I am now almost six months pregnant with our first child. Our son is due on Nov. 12, 2020, and we could not be more excited.

Why it’s all been worth it

Starting a family this way was not easy. The egg retrieval process alone required hundreds of shots, lots of medication, countless ultrasounds and a bunch of lab work. Being pregnant during the COVID-19 pandemic is no picnic, either.

But knowing that my son will not have CDH1 — and that his risk for cancer will be no higher than the average person’s — means everything to me. Now, I’ll be able to rest easier whenever he throws up or complains of a tummy ache, knowing he isn’t any more likely to develop stomach cancer than any other child. That alone makes it all worth it.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

In 2016, my husband and I were trying to expand our family. A swollen lymph node almost derailed our plans entirely.

I’d felt the lump in my neck by chance one day, when I rubbed my hand along the underside of my jaw. I thought it was an abscess caused by a failed root canal.

It turned out to be advance stage high grade B cell lymphoma, a subtype of non-Hodgkin lymphoma.

Though grateful not to be pregnant at the time, I was still devastated by the thought of not being able to have more children. I knew certain cancer treatments could leave me infertile, and my husband and I had always planned to have three kids. We were hoping to give our two little boys a sister.

Fortunately, I went to MD Anderson for my non-Hodgkin lymphoma treatment. My doctors there not only gave us hope that we could still have more children — they also gave us options to maximize our chances.

Exploring fertility-preserving options before non-Hodgkin lymphoma treatment

I was already 35 at the time of my non-Hodgkin lymphoma diagnosis, so I wasn’t sure how much my age would affect my fertility. Cancer patients are usually advised to wait at least two years after completing chemotherapy before trying to conceive. That timeline would put me just shy of my 38th birthday.

I wasn’t interested in freezing my eggs, but wanted to explore my options. So my oncologist, Dr. Hun Ju Lee, referred me to reproductive endocrinologist Dr. Terri Woodard to discuss my fertility preservation options. Ultimately, my husband and I decided on one of the least-invasive: leuprolide injections. These are an experimental type of therapy designed to shut down the ovaries, theoretically making them less vulnerable to damage from chemotherapy drugs.

I received the first leuprolide injection in July 2016, a few weeks before starting my chemotherapy infusions. I got a second injection in October 2016.

We waited the full two years before trying for a baby again. Our daughter was conceived just two months later, in February 2019. She was born that November, perfectly healthy.

I knew I was in good hands

My husband and I were pretty surprised that I got pregnant so quickly. But once I did, I felt like this baby was meant to be.

I hadn’t even been sure of what I wanted anymore, family-wise, or what was possible after I finally achieved remission. And I struggled with fears of the physical toll another pregnancy might have on me, as well as any possible risks to the baby, due to my health history.

Still, I knew I was in good hands at MD Anderson. Its doctors have so much experience with cancer. They really have seen all types and kinds. And they also have tremendous research efforts going on, which are helping other cancer patients through clinical trials. I’d been living in Houston for 10 years by the time I was diagnosed with lymphoma, so it felt like I was supposed to be there.

After six cycles of chemotherapy and surgery to remove the affected lymph node, my cancer is still in remission. So, I know MD Anderson was the right choice for me. My family is complete now. And I feel great.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Patients' fertility can be affected both during cancer treatment – when an unplanned pregnancy could be a serious problem – and later, if the cancer treatment causes infertility. For patients who want to have children, this can be devastating. But new advances are giving hope – and options – to patients who want to have children.

Here Terri Woodard, M.D., who leads the MD Anderson Oncofertility Consult Service, answers 10 questions she often gets about fertility and cancer.

1. Can cancer treatment cause infertility?

Some cancer treatments can, while others do not. The most common types of treatments that affect fertility include surgery that involves removal of the reproductive organs, certain types of chemotherapy and radiation to the abdomen and pelvis. We do not know how some newer treatments may affect fertility. 

2. How will cancer treatment affect my fertility?

How cancer treatment affects your fertility depends on many things, including the type of treatment you receive, your age and your current fertility status. Some people might be temporarily infertile while others may have permanent infertility. Your doctor can help estimate your individual risk.

3. How long will we need to prevent pregnancy during cancer treatment?

You should abstain or use a reliable form of birth control while you are receiving cancer treatment. You also shouldn’t try to conceive within six months of finishing chemotherapy because it may increase the chances of miscarriage or having a baby with a genetic complication. 

4. After cancer treatment, how long should I wait to conceive?

Determining when it is OK to conceive requires thoughtful discussion between you and your health care team. The timing varies between patients and types of cancer. Generally, women should wait at least two years before trying to conceive. This allows enough time for you to get beyond the window of an early cancer recurrence and allows your body to recover from the effects of treatment. If your cancer treatment has caused late effects that might make handling pregnancy more difficult, it may be recommended that you see a maternal-fetal medicine specialist prior to trying to conceive.

5. My partner is pregnant. Is there any reason to avoid sex during my cancer treatment?

Chemotherapy can be excreted in semen and vaginal secretions, so a condom should be used to prevent your partner from being exposed to it. It is possible that exposure could cause fetal abnormalities. If your white blood cell counts or platelet counts are low, your oncologist may advise you to abstain from intercourse because you may be at increased risk for infection or bleeding. 

6. What fertility preservation options are available for women preparing for cancer treatment?

There are several different ways that we can preserve fertility for women. The most common and accepted way to do this it to use assisted reproductive technologies (ART) to freeze eggs and/or embryos.  For patients who will receive high doses of radiation to the abdomen and pelvis, ovarian transposition is a surgical procedure that moves the ovaries out of the radiation field so that they are not harmed. 

Another option is suppressing the ovaries with medication to make them more resistant to the effects of chemotherapy; this is considered experimental.

Freezing ovarian tissue is the only option for girls who have not gone through puberty yet. It is also considered experimental, though children have been born using this method. 

7. What fertility preservation options are available for men preparing to undergo cancer treatment?

For men, the most common and accepted way to preserve fertility is to bank sperm before starting cancer treatment.

For boys who haven’t gone through puberty yet, the only option for fertility preservation is to freeze pieces of testicular tissue. This is considered an experimental procedure.

8. I stopped having my period. Could I still get pregnant?

It depends. Some cancer treatments cause women to stop having periods, but this may be temporary or permanent. Thus, a woman may become pregnant if she ovulates (releases an egg) before her periods come back. If her periods stop permanently, she is in premature menopause, and it is highly unlikely that she will become pregnant. 

9. What should I ask my doctor about cancer and fertility?

You should ask if your treatment might cause infertility and, if so, what your personal risk is. You should also ask about ways to preserve or protect your fertility before you start treatment. If you would like to learn more, ask your doctor to refer you to a fertility specialist, who can counsel you about your risk and provide fertility preservation treatments. If you’re a patient at MD Anderson, ask for a referral to the MD Anderson Oncofertility Consult Service.

10.  When should I talk to my doctor about my fertility?

You should talk to your doctor about your fertility concerns as early as possible in the course of diagnosis and definitely before you start treatment. The earlier you have the conversation, the more options you have if you decide to pursue fertility preservation treatment. However, even if you did not have the opportunity to discuss your concerns prior to treatment, you should still talk to your doctor about them because you can still think about your plans for parenthood after cancer.

As a reproductive endocrinologist and infertility specialist at MD Anderson, I bridge oncology and reproductive medicine to expand family-building options for cancer patients.

About 10% of people diagnosed with cancer are of reproductive age. My goal is for them to have the option to undergo fertility preservation before starting cancer treatment. I also want to discuss their family-building options after they’ve completed cancer treatment.

I believe that a cancer diagnosis should not keep you from having the family you’ve always wanted.

Why oncofertility is important in cancer care

I spent many years caring for fertility patients – that is, people who seek medical treatment in hopes of conceiving a child. And I found that many of my patients had been impacted by cancer. I wanted to do all that I could to help them. That led me to specialize in oncofertility; I now focus strictly on reproductive options for people with cancer.

There is much that is still unknown about the reproductive impact of many cancer therapies. So, my research focuses on exploring the treatment-related impacts and providing better counseling for people preparing to undergo cancer treatment. I want to learn more about how treatment can impact their future fertility and help us improve fertility preservation options.

The good news is that most people treated for cancer will become long-term survivors. A big part of their survivorship is the desire to have children in the future. I’m passionate about expanding their options and talking to patients about how to protect their fertility before they start treatment.

For me, it’s personal

My family knows firsthand how important oncofertility is. My husband is a cancer survivor, and he was initially treated at MD Anderson almost 30 years ago. We have three wonderful children, largely due to fertility preservation.

I’ve seen the type of care MD Anderson provides to its patients. It’s unsurpassed. My husband is doing so well largely because of the commitment and effort of his physicians who cared for him and continue to care for him today. And now we have a beautiful family.

Because of that outstanding care he received, I knew I wanted to work at MD Anderson. Now, as a faculty member, I’m able to give back by providing my patients the same quality care my husband received. It’s truly rewarding.

Patients are our No. 1 focus

I love working at MD Anderson because our patients are at the heart of everything we do. We view it as our passion, not a job. We want the very best for every patient we see, and we care for them as though they are members of our own families.

Cancer treatment isn’t just about the physical aspects of undergoing therapy. For so many of the young patients I care for, future fertility and having a family are extremely important. So, if we focus solely on their cancer treatment and ignore these other important aspects of their care, we are not doing the best we can for our patients.

At MD Anderson, we focus on the entirety of the patient’s care and what’s important to them. That’s one way we’re able to sustain long-term relationships with patients. We have patients who stay in touch with us 10, 20, 30 years down the road. They send us photos of their families, including milestones in their children’s lives. And we love celebrating those successes with them. There is nothing more rewarding than seeing patients live the lives they were always intended to have.

As I tell every patient: a cancer diagnosis does not define you nor does it limit you in terms of what you see for yourself and your future family.

Laurie McKenzie, M.D., is a reproductive endocrinologist and infertility specialist at MD Anderson.

Request an appointment at MD Anderson online or call 1-877-632-6789.