Several studies have shown that cancer treatments, such as chemotherapy and radiotherapy, can have temporary or even permanent effects on fertility by damaging the ovaries or testes. The multifaceted sense of grief from losing your fertility can be strong for people of all ages and coping with it is not an easy matter.
'Will cancer make me infertile?' is the first episode of That Cancer Conversation by Cancer Research UK. This episode explores infertility and cancer through three independent stories of two women and a man, who were diagnosed with cancer early in their life and whose fertility was affected in some way after receiving treatment.
The episode features Professor Richard Anderson, deputy director of the University of Edinburgh's Centre for Reproductive Health, who talks about the different available options to address infertility.
The first person to tell his story is Max, who was diagnosed with testicular cancer at the age of 15. Throughout his account, I think the most striking theme emerging is his difficulty in speaking out to his family and loved ones, and the constant feeling of embarrassment and shame surrounding his cancer diagnosis. In addition, being introduced to the topic of infertility, at an age when having children is the least of concerns.
Warned in advance that the operation and potential future chemotherapy treatment could have reduced his fertility significantly, Max made the decision prior to operation to freeze and store his sperm. He then underwent multiple surgical operations to remove the lump from his testis and from the lymph nodes to which the cancer had spread. As the surgery was very invasive, Max is currently infertile, mostly because his sexual health has been affected by the operation, but he was fortunate enough to be able to store his sperm in case he decides he wants to have children in the future.
But not everyone is lucky enough to be able to produce sex cells, often due to age or other underlying health issues. Therefore, one begins to wonder: is freezing sperm and egg cells the only viable alternative to natural reproduction? Interestingly, in a paper published in the Lancet and first-authored by Professor Anderson, testis and ovarian tissue re-implantation procedures (following cryopreservation) have recently emerged as novel interventions to treat infertility. However, Professor Anderson highlighted that both procedures are invasive and potentially risky, and are regarded as experimental in most countries.
The second story featured Eleanor, who was diagnosed with a molar pregnancy, a rare complication of pregnancy characterised by the abnormal growth of placental tissue and no fetus development, which can sometimes develop into cancer. After several urine and blood tests and a scan, she was told that she was not carrying a baby and that she had cancer. Following an evacuation procedure to remove the molar pregnancy, Eleanor underwent chemotherapy treatment.
Unlike Max, Eleanor's fertility was not affected by the cancer treatment, but she was advised not to fall pregnant for a while to avoid potential risks for hers and her future baby's health. The aspect that interested me more of this conversation was Eleanor's response to the situation: biological clock anxiety and intra-couple struggles to accept the consequences of these long and time-consuming procedures and to mutually support each other – are only a few of the side-effects of this extremely distressful situation.
Finally, Kreena's story is perhaps the one that I found most heart-breaking: after being diagnosed with breast cancer, she underwent a mastectomy, radiotherapy, chemotherapy and eventually she was put into medical menopause at only 33 years old. Women with this condition that want to preserve their fertility face very tough choices which need to be made not only under severe emotional distress but also very quickly before the treatment starts. I think Professor Anderson conveys very well here how quick-decision making is important when choosing an alternative reproductive option. It is also crucial for the carers to raise the topic of infertility and inform the patient immediately of the available options.
But being able to have children isn't the only factor at stake. When Kreena speaks about feeling 'stripped' of her femininity, with a 'hollow body', and questioning whether she can be 'still attractive to her husband', you really understand how upsetting these experiences are and how strongly it can affect one's self-confidence and mental health.
I was a bit disappointed that throughout the three stories Professor Anderson barely touched upon the topic of 'what the future of fertility medicine could look like', as promised by the introductory paragraph to the podcast. I would have liked to hear more about novel studies to reduce side-effects and improve the quality of life of the patient. Indeed, current treatments and their dreadful side-effects have been well-known for decades, it would have been interesting to know more about how scientists working in the field of reproductive health are thinking to overcome these caveats.
Undoubtedly, Professor Anderson provides a clear overview of the currently available interventions to treat infertility, but the scientific focus is clearly missing, giving more space to Max, Eleanor and Kreena's stories. The podcast wanders through the intense personal experiences of the three characters, making it probably less attractive to people who are interested in knowing more about novel alternative reproductive choices and about the science behind them. Overall, I think the podcast fits well to a charity channel audience: cancer patients and their families can look for comfort and learn how to accept and cope with cancer and its consequences by relating to people who went through a similar journey.