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Fertility Preservation from an Oncologist’s Perspective

By: Dr. Pooja Rao  

One of the most emotional parts of my job as an oncologist is talking to my patients about the potential of the cancer therapy they will receive to affect their fertility (ability to have biological children). I can recall countless discussions I have had over the years with patients about cancer and the side effects of the therapy I prescribe to them. More often than not, discussions related to potential impact on fertility is what prompts the tears to flow. Many times, it is not just the patient in tears, but also their parents and partners. The tears happen for so many reasons I can understand, and perhaps for reasons I cannot. Not being able to have children is overwhelming to think about – especially after just being told the bombshell news of having cancer. For many of my patients, they have never thought about having biological children, and for others it has been a lifelong dream. Cancer therapy’s potential to impact their chance to have biological children in the future forces them to think about these issues in an urgent, often uncomfortable way.   

The complexity of this discussion increases when I take care of patients who are adolescents and young adults. They may feel embarrassed to be talking about this topic with their parents (or partners) present, especially when I discuss ways to preserve fertility, such as sperm banking or egg freezing, which can be quite personal, awkward and invasive. They struggle with the idea of how they will feel in the future about having children, even if they don’t want to have a child now. They may have a different perspective on fertility than their parents or partners, and often have to juggle these differing opinions as they make a decision for their own future. Fears and worries about cost are also common, understandable concerns.   

As a doctor, these discussions fill me with many emotions.  I feel frustration that I can’t give patients and families exact numbers for risk of infertility for them in particular – information that may be helpful to guide decisions. Anger that while we have options to offer patients to preserve fertility, some cannot, for a variety of reasons, access fertility preservation prior to starting cancer therapy. The biggest feelings for me though is guilt – guilt that the chemotherapy medications that I prescribe can cause awful side effects for my patients and affect their lives in profound ways.  

The pain of not being able to have a biological child when it is something you desire is deep, dark and lonely. I want to do everything I can to give my patients and families accurate information about fertility preservation, present available options and help guide decisions, all in a timely manner. We are fortunate here at Penn State Health that we have doctors in our Reproductive Endocrinology and Infertility Division who feel the same way. We have partnered together to create a Fertility Preservation Task Force that aims to make the process of discussing fertility and accessing fertility preservation services smoother. While we have made significant progress, but there is still work to be done.  

As doctors, we want to give our patients a chance at living a life filled with what is meaningful to them. Having a personal diagnosis of cancer, especially as an adolescent or young adult, takes away control that young people have to live lives with meaning. Cancer forces them to make many sacrifices about major life decisions, whether that be the ability to have biological children, go to college or maintain important relationships. It is hard to imagine making decisions now about your future life, especially when you are young and dealing with a life-threatening illness. I hope, as a physician, that I can make that exhausting process a little bit easier for my patients by leaving doors open for them to be able to make life choices in the future- on their own terms. 

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