ctress Christina Applegate announced that she and her fiancé, Porno for Pyros member Martyn Lenoble, were expecting their first child. Are you wondering what this bit of celebrity gossip is doing in a health column? Don’t worry, The Diplomat hasn’t turned into Us Weekly. With her pregnancy, Applegate joins a small but rapidly growing group of rather unusual parents: those who have children after having had cancer. No one keeps statistics on how many cancer survivors, male or female, go on to have children after undergoing treatment. But we can make some pretty good guesses that there are probably thousands. According to Fertile Hope, a national organization that provides reproductive information for cancer survivors, approximately 120,000 men and women under the age of 45 are diagnosed with cancer every year. Of the more than 9 million cancer survivors alive in the United States today, about 10 percent — or 900,000 — were diagnosed in their reproductive years. And these numbers are likely to increase because cancer survival rates are dramatically increasing, with the average five-year survival rate for patients under the age of 45 at 71 percent. At the same time, women are choosing to delay childbearing longer, into their 30s and 40s — making it more likely that they may confront cancer before becoming pregnant. So what does cancer do to your chance of having children? It depends on the kind of treatment you have. Applegate was fortunate in that sense. Her breast cancer, diagnosed in 2008, was caught early, and she also chose to have a prophylactic double mastectomy when genetic testing revealed that she carries the BRCA1 genetic mutation, which dramatically raised her risk of cancer in the other breast. Because of those factors, she didn’t have to undergo either chemotherapy or radiation, both of which can potentially be harmful to either female or male fertility. Unlike Applegate, however, about half of all people diagnosed with cancer during their reproductive years do receive treatments that can affect their fertility. Some kinds of chemotherapy can cause an early — and sometimes permanent — menopause. Radiation can destroy sperm or scar the uterus in a way that may make it impossible to carry a pregnancy. But exciting progress is being made in research aimed at helping cancer survivors improve their chances of having children. There are already some good options — egg and embryo freezing for women, sperm banking for men — but these don’t always work for everyone. There are now more than 50 medical centers in the United States providing what’s called “oncofertility” services, and in 2007, researchers at Northwestern University’s Feinberg School of Medicine received a first-of-its-kind million grant from the National Institutes of Health to develop ways of protecting cancer patients’ reproductive health. They lead a national Oncofertility Consortium that has several dozen member centers across the country, dedicated to both providing fertility preservation services for people with cancer and advancing research into cancer and fertility. (To find out more, call their “Fertline” at (866) 708-3378, or visit them online at www.myoncofertility.org.) There have already been some amazing breakthroughs. In mid-September, researchers at Brown University and Women and Infants Hospital in Providence, Rhode Island, announced that they had created the world’s first “artificial ovary” — a lab-created cell structure that mimics the environment of a real ovary, in which eggs can mature outside the body. Right now, some women facing cancer treatment choose to have eggs harvested and frozen for use in later IVF treatments, but frozen eggs don’t always survive the thawing process. Eggs extracted and allowed to mature in an artificial ovary would likely have a much better chance of survival. Another promising area of research — one that’s already led to the birth of several babies — is ovarian tissue cryopreservation. That’s when doctors remove strips of tissue from a woman’s ovary prior to cancer treatment, preserve them, and then later on, after the damaging effects of chemotherapy or radiation are past, transplant that tissue back into the woman. This technique was wildly experimental back in 1998, when Amy Tucker was diagnosed with Hodgkin’s lymphoma. Sheldon Silber, a pioneer in the field of oncofertility, had only used it in the lab. But Tucker, facing a bone-marrow transplant, full-body radiation, and chemotherapy, decided it couldn’t hurt to try. Eleven years later, Tucker and her husband decided they were ready to try to have a family. In January 2009, she had Silber implant the preserved tissue back into her ovary. It took a few months for the ovary to start functioning again, but once it did and Tucker’s menstrual cycles returned, it took only four months for her to get pregnant. Baby Grant Patrick was born on May 27, 2010. And back in February, a Danish woman, Stinne Holm Bergholdt, became the first woman to give birth twice after ovarian tissue transplantation. Oncofertility specialists are also studying other options, including various ways to protect the ovaries and their maturing eggs during chemotherapy. For example, the drug Gleevec, which has revolutionized the treatment of chronic myelogenous leukemia (CML), could also help preserve fertility during cancer treatment. In a 2009 study, Italian researchers found that the chemotherapy drug cisplatin destroys eggs by damaging a particular enzyme. Gleevec, they found, stopped the egg damage caused by cisplatin. This research was done in mice, so it’s a long way from being available to patients at this point — but it represents yet another possibility that may someday help cancer survivors to have children. Ultimately, the point is this: If you’ve been diagnosed with cancer, you don’t have to give up your dream of becoming a parent, or having more children. There are lots of options — in addition to fertility preservation, you could consider donor eggs, embryo adoption, surrogacy, or adopting either domestically, internationally, or from foster care. If you have love to give to a child, there is a path to parenthood for you. It may not be the one you envisioned when you were 8 years old and caring for your baby dolls. It may be more complicated and probably more expensive. But as the many cancer survivors who’ve become parents — including me — will tell you, it will be worth it.
About the Author
Gina Shaw, a contributing writer for The Washington Diplomat, is a six-year survivor of breast cancer who has both adopted and had biological children since her diagnosis. Her book,