Wellness

Fertility and Cancer: Surviving and Having Kids Too

A new field of fertility medicine helps cancer survivors have babies after treatment

By Bonnie Rochman Monday, Oct. 11, 2010
    • Tamara Shopsin and Jason Fulford for TIME

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    Dr. Sherman Silber, who treated Tucker, counts more than 60 specimens of frozen ovarian tissue "under lock and key" in his lab at St. Luke's Hospital in St. Louis. The procedure requires only small samples of ovary, since its payload of follicles is located in the outer millimeter of tissue, which is transplanted back in strips. Each week, Silber says he consults with another regretful cancer survivor who never froze her ovarian tissue because her oncologist had discouraged it or, worse, failed to even tell her about the possibility. "We should have 1,000 frozen," says Silber, who heads St. Luke's Infertility Center.

    For many women with "liquid" cancers like Hodgkin's lymphoma or leukemia, however, ovarian transplants may not be ideal because the blood-borne nature of the disease means that cancer cells could have infiltrated the ovary. But such patients' options are expanding. In September, Brown's Carson announced that she had helped develop an artificial ovary that could one day be used to nurture immature eggs harvested from cancer patients to full maturity. And in Woodruff's lab at Northwestern, consortium scientists are working on other methods of maturing ovarian follicles outside the body, coaxing them in petri dishes into full-fledged fertilization-ready eggs. Developing eggs outside the body circumvents the need to reintroduce potentially cancerous ovarian tissue. "If we could get this right, it could change the way cancer diagnosis affects young women," says Woodruff.

    The Costs and Questions
    The evolving science aside, cancer patients face other roadblocks to fertility, like insurance—or, rather, the lack of it. Hardly any insurance plans cover cancer-related fertility preservation (freezing eggs or embryos costs $8,000 to $15,000), even though they pay for procedures like hair-loss treatment after chemo and postsurgery breast reconstruction. In the March issue of the Journal of Clinical Oncology, Lisa Campo-Engelstein, a senior research fellow at the Oncofertility Consortium, argued that infertility should be treated no differently from any other postcancer health issue. "Cancer patients are not infertile in the traditional way," says Campo-Engelstein, who is helping draft new federal regulations for pretreatment coverage. "If they want to preserve their fertility, they need to do that before their cancer treatment."

    Then there are ethical minefields some patients must pick their way through. Consider cases of childhood cancer, for example. Should young girls have their ovaries harvested? "There could be an 8-year-old girl who doesn't even have a concept of what it means to reproduce and be a mother," says Dorothy Roberts, a professor of law at Northwestern University who specializes in reproductive rights and bioethics. Amid the philosophical debate, life and science march on. In April at Brown University, ovarian tissue was removed from an 18-month-old girl with cancer; she is believed to be the youngest child to undergo fertility preservation.

    Even within the Oncofertility Consortium, experts have debated whether the ability to have biological children should be regarded as so critical. (Research shows that many cancer patients prefer conception to adoption.) At least two reasons it matters: studies suggest that adoption agencies tend to reject cancer survivors, and perhaps more important, the mere idea of having a baby can prop up a woman reeling from a diagnosis. "The overriding devastation we hear from women is that they won't be able to be parents," says Corey Whelan, program director at the American Fertility Association, a patient-advocacy organization.

    That is why Teresa Woodruff in late September traded her white lab coat for a brown linen suit and addressed the Congressional Caucus for Women's Issues, which indirectly funds the consortium's work. She thanked the caucus for its support and pledged that the consortium's scientists, bioengineers, doctors, ethicists and academics would not rest until they solved the problem of having cancer and having babies. Because science owes it to people like Holly Trandel, preparing for her Mediterranean honeymoon cruise, to address not only that they survive but also how they live.

    This article originally appeared in the October 11, 2010 issue of TIME.

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