Infertility

The ability to conceive a child is an issue with many different types of cancer, may affect both men and women, and can result from both adult and childhood cancers and treatments. Infertility can also be seen as a tragic consequence (a "double whammy") of surviving a life-threatening disease. For some people infertility is a source of terrific loss and may bring about intense feelings of sadness, shame, worry, and anger. Just the possibility of future infertility can interfere with relationships. As one of my patients who had Hodgkin's lymphoma as a child says, "At what point do you tell someone you are dating that you might not be able to have children?" The inability to have the family you always dreamed of can be a terrible blow. Coupled with an uncertain future and your own brush with mortality, it can be genuinely devastating.

Infertility may come as a surprise or may be an expected outcome of the cancer treatment. It may also be temporary, for example, when a young woman with breast cancer goes into menopause during chemotherapy treatment and then several weeks or months after the end of treatment resumes ovulation and menstruation. Sometimes a couple can plan ahead and "bank" frozen sperm or eggs. This procedure is not always helpful, though: for example, a woman with uterine cancer who has her uterus removed still won't be able to carry a child—though engaging a surrogate mother might be an option.

Dr. Brian Foley, my colleague with an oral cancer whom I quoted in Chapter 2 (writing about healing, he said he would "cultivate the garden of me" and focus "not exclusively on the weeds [tumor], but on nourishing and supporting the garden") also described his initial reaction to reading the fax that his doctor sent to his home and how his thoughts immediately focused on his future ability to raise children: "I read aloud, 'squamous cell carcinoma tumor present on all margins.' . . . I was shocked. No denial. No disbelief. I felt only anger. Some say there is a reason for everything. That was not an acceptable explanation for me. What was the reason for this? Why did Linda [his wife] have to get this news? She deserved better. Would we ever have our own children? Would I make my young wife a single mother and widow?"

Even if you already have children, the loss of the ability to have more may be a severe blow. A childhood friend of mine had a hysterectomy to treat cervical cancer. She has five children, but she had planned on having a very large family. Another woman I know had a similar procedure for cervical cancer, has one child and also had intended to expand her family in the future. Each woman talked to me about how devastated she was to have her uterus removed. The number of children they each already had didn't impact their feeling of loss.

If you are concerned about childbearing issues, talk to your doctor and seek out specialists in the area of reproductive medicine. This field is rapidly changing, so there may be options for you that you didn't real ize existed. The more information you have, the better you will be able to make a decision that is right for you and your family.

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