The story of Asha* (32) and Ajith* (34) is one that Team Nova holds close to our heart. Life was full of promises and dreams for this couple—it had just been a few years since their marriage, they were young and happy and successful—until their world turned upside down with Asha’s breast cancer diagnosis. Once they were over the initial shock, they decided to come up with an effective, practical plan to fight cancer as a team.
Infertility: The Inevitable Aftermath of Cancer Treatment
While doing research for a well-rounded cancer care plan, the couple discovered that the treatment could affect Asha’s ability to conceive in the future. While certain treatment options for breast cancer are linked to temporary infertility and difficulty to conceive naturally, others may cause irreversible menopause and permanent infertility.
- Hormonal Therapies: There are three types of hormonal therapies approved for treating cancer in premenopausal women: tamoxifen, Fareston (chemical name: toremifene) and Evista (chemical name: raloxifene). These therapies may disrupt the ovaries from releasing eggs and lead to irregular periods. Though most women remain fertile and their menstrual cycle gets back on track after a while, some women find it hard to conceive naturally once the treatment is over.
- Chemotherapy: Chemotherapy drugs majorly focus on destroying cells that divide quickly—which is why even healthy cells like hair follicles get targeted and eliminated. An oocyte (immature egg) in a woman’s ovaries is another type of cell which divides at a fast pace. Chemotherapy involves aggressive drugs like Cytoxan (chemical name: cyclophosphamide) that can damage oocytes and cause permanent infertility. Milder chemotherapy drugs like Platinol (chemical name: cisplatin) and Adriamycin (chemical name: doxorubicin) carry a medium risk of affecting fertility.
- Radiation: Radiation or radiotherapy uses high-energy waves to eliminate cancer cells and shrink tumours. Though radiation therapy performed on breasts may not directly affect the ovaries, the energy waves may reach the uterus through internal scatter and cause temporary difficulties in conception. But if the radiation is delivered to other parts of the body like the abdomen or pelvis due to cancer spread, it could affect the blood supply of the uterus and raise the risk of miscarriage, pre-term birth, low birth weight or other complications during pregnancy/birth.
Planning Parenthood in the Shadow of Cancer
The prospect of a future without children further disheartened the couple, but they were not willing to back down without a fight. They decided to visit Dr. Apurva Satish Amarnath of Nova IVF Fertility, Kamanahalli (Bangalore) to figure out a way to ensure that they can start a family once Asha was done with her cancer treatment.
Dr. Apurva, in concordance with Asha’s oncologist, discussed the three options the couple could consider—fertility preservation, the usage of donor oocytes and adoption. Though it was a tough decision to make at the time, Asha and Ajith decided to opt for fertility preservation, as their hearts were set on having biological children of their own.
Cryopreservation: The Silver Lining In The Storm Cloud of Cancer
Cryopreservation is the principal fertility preservation method that involves storing live cells, tissues or organs at subzero temperatures to maintain their viability. Women about to undergo cancer treatment could choose to freeze their eggs or embryos via cryopreservation so they can conceive in the future, post recovery.
The decision to undergo cryopreservation should be taken after considering various factors including the woman’s age, oncology treatment plan and ovarian reserve.
- Age: Eggs and embryos preserved at a younger age—ideally, below 35— are more likely to lead to a successful pregnancy. Fortunately for the couple, Asha was within the age group doctors usually deem optimal for egg freezing; 25-35.
- Oncology Treatment: Cryopreservation needs to be done before the cancer treatment begins. So, it can be done only for those patients who can delay their oncology treatment long enough to complete the process of freezing their eggs/embryos.
- Ovarian Reserve: Ovarian reserve refers to a woman’s fertility potential based on the number of eggs remaining in her ovaries. A woman is born with her entire life supply of eggs, which then continues to diminish with each menstrual cycle until she finally hits menopause. Ovarian reserve testing is vital before cryopreservation as this can help tailor the woman’s ovarian stimulation protocol (required if the woman plans on undergoing IVF to cryopreserve her embryos).
Preserving Hope: Cryopreservation at Nova IVF Fertility
As Asha was young, healthy and could wait until cryopreservation was done to start her cancer treatment, the couple decided to go ahead with IVF and freeze the embryos thus obtained.
The procedure was completed successfully under the expertise of Dr. Apurva, and with one battle won, Asha geared up to fight an even bigger one—chemotherapy.
In the case of breast cancer, a patient should complete the 2-year period of recurrence observation after the completion of chemotherapy to ensure they are disease-free. Accordingly, the couple consulted Dr. Apurva 3 years after Asha’s treatment to resume their fertility journey. Today, they are the proud parents of a beautiful, healthy baby girl.
Asha’s story teaches us how the greater the storm is, the brighter the rainbow will be. It should also be a wake-up call for all the young men and women who are battling cancer—gone are the days when there were no options to pursue parenthood after oncological procedures. You live in an era of advanced ART methods and fertility preservation. Your oncologist may not bring up the topic of fertility—it is up to you to explore your options and figure out a plan that suits you.
A Note from Dr. Apurva Satish Amarnath
“Cryopreservation should be a choice rather than an option.
Over my decade-long stint as a fertility consultant, I have noticed the growing trend of well-educated men and women postponing parenthood for the sake of career goals or because they haven’t come across an ideal partner. This group of individuals should consider Cryopreservaing their gametes as a realistic technological fix to a biological and sociological dilemma.
For many women, it is not cancer but the passage of time that denies them the window of motherhood. Regardless of what the reason is to put off parenthood—be it social, education or financial—the biological clock stops for none.
Hence cryopreservation, whether performed due to cancer or for social reasons, is a viable “Plan B” for individuals who would otherwise end up childless, involuntarily.”
*Names have been altered to protect the identity of the couple.