Tue, Apr 28, 2009 - Page 16 News List

When cancer gets in the way of family planning

Loss of fertility among cancer sufferers is often overlooked by doctors and patients, who may survive their disease but be left unable to reproduce

By Jane E. Brody  /  NY TIMES NEWS SERVICE , NEW YORK

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If his mother hadn’t struck up a conversation with a stranger in a waiting room, Dan Shapiro would never have become the biological father of Alexandra, 13, and Abigail, 9. Dan was a 20-year-old junior in college when doctors diagnosed stage 2 Hodgkin’s disease. His treatment was to be six cycles of highly toxic chemotherapy followed by radiation.

He and his mother were waiting in the doctor’s office to discuss therapy when his mother began chatting with a woman whose 14-year-old son was being treated for leukemia, Shapiro, now 42 and a professor at Penn State College of Medicine, recounts in his delightful book, Mom’s Marijuana (Harmony Books, 2000).

“Has he banked sperm?” the woman asked Mrs Shapiro. “He should bank sperm. I had my son do it.” To which Mrs Shapiro replied, “I didn’t realize the treatment would make him sterile; the doctors haven’t said anything.”

At Mrs Shapiro’s insistence, Dan’s treatment was delayed long enough for him to bank sperm, which for a few hundred US dollars a year was kept frozen until he was ready to start a family nine years later.

A NEGLECTED ISSUE

Although more attention is now paid to loss of fertility among cancer patients, it is still too often overlooked by oncologists and patients, who may survive their disease but be left unable to reproduce. Neglect of fertility issues is especially common in cases involving children yet to reach puberty.

Yet in guidelines issued nearly three years ago, the American Society of Clinical Oncology stated that “any oncologist seeing reproductive-aged patients for consideration of cancer therapy should be addressing potential treatment-related infertility with them or, in the case of children, with their parents.” The guidelines noted that “sperm and embryo cryopreservation are considered standard practice and are widely available.”

What often happens instead is that patients, who are naturally terrified by the diagnosis and focused on survival, fail to ask whether treatment will leave them infertile. And oncologists, who are focused on beginning effective treatment as soon as possible, fail to consider the effects on their patients’ future fertility.

The University of North Carolina’s Fertility Preservation Program estimates that only a quarter of oncologists nationwide address fertility issues with patients before treatment begins.

In December 2007, Margaret Kresge Poe of Atlanta was 32 and getting ready to start a family with her husband when she was shocked to discover that what she thought were hemorrhoids was stage 3 rectal cancer. The proposed treatment — surgery, chemotherapy and pelvic radiation — would have left her unable to bear children, yet the doctor never mentioned an effect on her fertility.

“It was family members who raised the issue,” Poe said in an interview. “At the time, I could barely think straight.”

Her treatment was delayed long enough to harvest eggs and have them fertilized and frozen as embryos, and Poe entered a clinical trial that used aggressive chemotherapy but none of the organ-damaging radiation that would have left her infertile.

“Hopefully,” Poe said, “we’ll have those embryos as real children before long.”

Each year, an estimated 16,000 women younger than 45 find out they have breast cancer, according to a report in February in the New England Journal of Medicine.

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