Because chemotherapy can affect a woman’s ability to have children, women of childbearing age faced decisions about whether to take steps to preserve their fertility before undergoing treatment. Some women did not consider fertility to be their priority in the circumstances and were comfortable accepting whatever happened. For others, particularly young women who hoped to have children one day, preserving their fertility was a major concern.
My husband is fairly certain that he doesn’t want to have any more children but I hadn’t really closed that off. With chemotherapy you can often go into menopause, especially if you’re closer to 40 or already closer to menopause. I thought that that was what was going to happen and that was pretty traumatic for me.
There are a number of ways to preserve fertility during breast cancer treatment. Doctors are looking into preserving fertility by: using treatment to produce embryos or eggs for freezing, reducing the impact of chemotherapy on fertility and trying to preserve ovarian tissue for use in the future. Several women took steps to preserve their fertility. The steps they used, included having Lupron injections and/or freezing their eggs prior to undergoing chemotherapy. Lupron (leuprolide acetate) is used to protect the ovaries from the impact of chemotherapy although its effectiveness is still unclear. It also produces side effects similar to menopause because it decreases estrogen levels.
I had to purposely take Lupron shots to protect my fertility because I found out that when doing chemotherapy you can become infertile. To me having children of my own in the future is a huge, huge importance in my life. I also ended up freezing my eggs prior to doing chemotherapy and not only did I freeze my eggs I agreed to take Lupron injections which put you under menopause.
A number of other women considered freezing their eggs in order to improve their chances of one day having children. Because this has to happen before the start of chemotherapy, the decision often had to be made very quickly in order not to delay treatment. Freezing eggs is an expensive procedure. At the time of these interviews, the treatment or part of the treatment is only covered by some provinces such as Quebec and Ontario. There are also parts of the country where egg freezing is not available so women living in those areas have to travel in order to have the procedure.
For a variety of reasons, several women decided not to freeze their eggs.
Interviewer: Did the healthcare professionals discuss with you the possibility that you would become infertile?
This all happened at the beginning right after I was diagnosed. It moved pretty quickly. They sent me to a fertility doctor because I was 29, and I had 4 days to decide what the options were. You could either freeze your egg, they also had these pills that would make a barrier in your womb but they were supposed to make you a lot more sick during the treatments.
I had the surgery and then 4 weeks later I was in Ottawa for an egg retrieval. That was... so much had to come together during that 4-week period because we were waiting for so long for... I had the surgery in March and then the pathology didn’t come back until weeks later.
While preserving their fertility was an important concern for many women, it was not an issue routinely raised by their cancer teams. While some women did learn about the issue from their oncologist, others only found out about it because it was mentioned by friends or by their family doctor. Melissa thinks that her cancer team did not outline the fertility issue clearly, fortunately her family doctor called her personally to inform her about the risk.
Yes, the fertility subject was a little difficult for me. I didn’t have much time to decide if I wanted to freeze egg cells. I think I had two days. I just had… it was a short time after my surgery; I was recovering from my operation. I had an infection and I think I didn’t even tell my spouse at the time. I didn’t really have time.