Getting Pregnant After Cancer

Will you be able to have a baby after being treated for cancer? Should you? Is it safe for you, and perhaps most important, for the baby? Ahhh, cancer–the gift that keeps on giving (or better yet, the curse that keeps on cursing). These are the $64 million dollar questions facing many cancer survivors. While only a woman or couple in close consultation with their oncologist and reproductive endocrinologist can make this decision, the current research is fairly optimistic for the health of the woman and any children she conceives. Of course, it is really not possible to do the rigorous prospective type research where woman cancer patients are randomly assigned to a group that has children or a group that does not and then followed for many years to determine outcome, but the studies of woman who have been treated for cancer and chose to have children have not found an increase in cancer reoccurrence, nor miscarriage, pre-term birth, low birth weight, or birth defects. We talked about all this and much more in yesterday’s Creating a Family show on Getting Pregnant after Cancer with Dr. Nicole Noyes and Dr. Jacqueline Jeruss. (Check out their credentials below to be truly blown away—these are some high-powered women!)

Difficult Decisions/Competing Goals

Although what limited research we have is fairly optimistic, depending on the diagnosis and cancer treatment required, that is not to say that the decision to attempt a pregnancy after cancer is without difficult decisions. Long-term treatments, such as tamoxifen, would have to be discontinued during the duration of the time trying to get pregnant and the pregnancy, even though there is clear evidence that long term survival from breast cancer is improved with its use. Dr. Jeruss gave one of the clearest discussions of how to balance the competing factors when deciding whether to stop tamoxifen treatment in order to have a child that I’ve ever heard.  I also appreciated the discussion on the show of the ethical issues of trying to become a mom as a survivor of a potentially deadly disease.

Lots of Options

Some cancer survivors will be able to get pregnant without help, but many will need fertility treatment to succeed. Infertility clinics have many options to offer (IVF, donor egg, donor embryo, surrogacy). Amazing advances are being made in helping women with certain gynecological cancers maintain a full term pregnancy after treatment. Paying for fertility treatment is getting easier for cancer survivors as well. Many fertility clinics offer significant discounts for cancer patients. It is also quite possible that your health insurance will cover infertility treatment if it is necessary to get pregnant as a result of cancer treatment.

Keeping Your Options Open

The good news is that we’ve made huge progress in the last several years in bringing awareness to fertility preservation before cancer treatment. Not all cancer treatments affect future fertility but many do, so without taking steps to preserve your fertility before treatment, the option of getting pregnant after cancer doesn’t exist. Grants are available, fertility preservation medications may be provided without charge (check out the Ferring Pharmaceutical HeartBeat program), and several groups are actively advocating for woman and men to be told of this option before treatment. In particular, check out the following great resources:

• Oncofertility Consortium and MyOncofertility.org
• Alliance for Fertility Preservation
• Fertile Hope
• Fertile Action

If you know of other resources for cancer patients who may want to either preserve their fertility prior to treatment or are considering pregnancy after treatment, please list them in the comments.

Have you faced this decision of whether to try to get pregnant after cancer? How did you decide? And where did you go for help?

* Dr. Jacqueline Jeruss is a breast surgeon, the Oncofertility Consortium’s Clinical Co-Director of Oncology, and an Assistant Professor within the Department of Surgery and a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

*Dr. Nicole Noyes, Reproductive Endocrinologist with NYU Fertility Center, Professor and the Director of Reproductive Surgery at the New York University School of Medicine and Medical Center, and President of the ASRM Special Interest Group on Fertility Preservation.