Has Baby, Had Non-Hodgkins Lymphoma
Annie Dauer was told by her oncologist that she would need a stem-cell transplant to cure her non-Hodgkins lymphoma. Because of chemotherapy involved, Annie was more concerned about what would happen to her ability to have children than anything else. Her oncologist was not concerned about it but Annie insisted and was referred to a fertility specialist. Now she has a two-year-old daughter and another one coming.
Welcome to the burgeoning world of oncofertility. As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties—oncology and assisted reproduction—to come together. "The narrative of cancer is no longer that it's a death sentence; it's a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle," says Teresa Woodruff of Northwestern University's Feinberg School of Medicine, who last fall received a first-of-its-kind $21 million NIH grant to develop ways of protecting cancer patients' reproductive health.
Of all those under 45 who have some form of cancer, about half will undergo toxic chemotherapy that will also target growing, fragile cells such as sperm, eggs and hair follicles. The good news is that more options are becoming available to those who want to have children - men can bank live sperm to be used in an in vitro fertilization process, women can freeze eggs or ovarian tissue and for those with partners the freezing of embryos. Hopefully the future will bring about ways to protect eggs and sperm from chemotherapy damage and perhaps the chemotherapy agents will be less toxic.
Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility. Advocacy groups like Fertile Hope, which educate cancer patients about assisted reproduction, deserve credit for spreading the word. "It's being talked about more," says Nancy Lin, an oncologist at Boston's Dana-Farber Cancer Institute. "There's a growing awareness among doctors, and patients are more proactive."
In Annie's situation her fertility specialist removed an ovary and froze it to be used after she recovered from the chemotherapy. Two years after her treatment Annie had a one-inch strip of ovary implanted just under her skin below the belly button. The plan was that her doctor, Kutluk Oktay, would then harvest mature eggs, fertilize with sperm from Annie's husband Greg and implant them into Annie's uterus. That never happened because, for some unknown reason, Annie's other ovary began to produce eggs and she became pregnant with her daughter Sienna.
Oktay is at a loss for an explanation. "The healthy ovary may contain signals or hormones that may enable the [dormant] ovary to regenerate eggs," says Oktay. "That's the theory, other than a miracle."
