When I was diagnosed with breast cancer as a 36-year-old newlywed, my husband and I had to put off our plans for trying to conceive our first child-and I joined an ever-growing club of younger cancer survivors. There are over a million people in America today who’ve survived cancer and are still under the age of 45, and 100,000 more men and women get diagnosed with cancer every year while still of reproductive age.
Pregnancy comes with an onslaught of challenges and questions for women with even the most humdrum of health histories. But for someone who’s had cancer, add a new list of worries to the ordinary ones you’d share with any other woman. Can you get pregnant? Should you? What are your options? Do you need to be watched like a hawk by a team of high-risk specialists?
Although both cancer itself and, more commonly, cancer treatments like chemotherapy, radiation, and surgery can wreak havoc on your fertility, the good news is this: many women who’ve gone through cancer treatment have gone on to get pregnant-either spontaneously, or with the help of fertility preservation and assisted reproduction-and have normal, healthy pregnancies and happy families.
I’m one of them. After we adopted our beautiful daughter less than a year and a half after I finished treatment, I was able to get pregnant when she was a toddler and gave birth to our son shortly before celebrating my 41st birthday. Two years later, we became a family of five when I gave birth at the reproductively decrepit age of 43. As I worked on a book about having children after cancer, I interviewed dozens of cancer survivors who had equally happy stories to tell.
But not every cancer survivor gets the information they need about family planning after treatment. Cancer treatment has long been a specialty that’s mostly focused on the older people who most commonly develop the disease, and long-term survival issues for younger people with cancer-like fertility and pregnancy–have only recently made it onto the radar screen. A 2009 survey found that less than 25% of oncologists give their younger patients educational materials on how they can preserve their fertility during treatment, or refer them to fertility specialists.
So what do you need to know about pregnancy after cancer? Here are the top five questions to ask yourself and your doctor.
1. How can I preserve my fertility during treatment? If you haven’t undergone cancer treatment yet, there are a growing number of techniques you can use to help preserve your fertility from the harmful effects of chemotherapy, radiation and surgery. Most common for women are egg and embryo freezing. Embryo freezing is currently considered more reliable, but the science behind egg freezing is advancing rapidly and experts believe that soon, women attempting to become pregnant using frozen eggs will have about the same success rate as those using frozen embryos (about 19-30%). If you’re going to have radiation directed at your pelvic area, there are also options like having your ovaries surgically moved away from the direct “line of fire.”
2. Can I become pregnant after cancer treatment? If you already went through cancer treatment and did not freeze eggs or embryos, you may wonder if it’s too late to save your fertility. But for many women, fertility returns to normal after cancer treatment. Age has a lot to do with it (doesn’t it always?). Generally, the younger you were when you received treatment, the more likely it is that your fertility will return to normal. The closer you were to 40, the more likely it is that your fertility has been permanently impaired.
It’s also important to understand that even if your fertility does return, you probably have a shorter window in which to become pregnant than the average woman. Women who have undergone chemotherapy usually go through regular menopause a few years earlier than they otherwise would have. Doctors generally advise most men and women to seek advice from a fertility specialist if they’ve been unable to become pregnant after trying for a full year. But for a cancer survivor, since you know there may well be fertility issues, most experts advise seeing a specialist if you haven’t been able to become pregnant within six months after you’ve begun trying.
3. Is it safe to become pregnant after cancer treatment?
For most cancers, the answer is an unequivocal “yes.” There is no biological reason to think that getting pregnant could lead to a recurrence of ovarian cancer, uterine cancer, thyroid cancer or lymphoma, for example.
But there has been some reason to worry about breast cancer. After all, many breast cancers are fueled by the hormone estrogen, which goes into overdrive during pregnancy. It stands to reason that pregnancy after breast cancer could spark a return of the disease.
So far, however, all of the studies done on the subject have reached the same conclusion: women who get pregnant don’t have any higher risk of having their cancer return than women who don’t get pregnant after breast cancer. The studies to date have all been relatively small, and experts are awaiting word from two much larger prospective studies on the subject, but based on what we know so far, breast cancer survivors can become pregnant without fearing a return of their cancer.
What about damage to the growing baby from the lingering effects of chemotherapy or radiation? Studies have shown that there appears to be no such effects. Generally, doctors will advise women who have been treated for cancer to wait at least a year, and preferably two, before becoming pregnant, but this is primarily because that two-year window after treatment is the time during which there’s the greatest risk of the cancer returning. If you’re pregnant at that time, there would be some difficult choices to make.
4. I’m pregnant and I’m a cancer survivor. Do I need high-risk obstetric care?
Probably not. If you are healthy enough to become pregnant after having had cancer, you are also probably healthy enough to receive regular obstetric care. I saw a midwife for my pregnancies, and one top oncologist told me that this can be a great model of care for cancer survivors because of the close personal attention midwives give. What you don’t want, she said, is a big, impersonal practice where you see a different obstetrician with every visit. You want someone who will get to know you well and notice very quickly if something seems a little off.
It’s always a good idea, though, to consult with your oncologist to make sure that there aren’t any lingering issues from your treatment that might make a pregnancy high-risk and require more specialized care. For example, if you have impaired heart function as a result of chemotherapy, the added strain of pregnancy on your heart may need to be watched closely by a maternal-fetal medicine specialist or cardiologist.
Women who get pregnant after cancer are often also of “advanced maternal age”-an awful-sounding term that just means you’re over 35. While many “AMA” women have pregnancies that are just as healthy and easy as their 25-year-old counterparts, it’s true that there are some increased risks, including a higher rate of miscarriage, placenta previa, and chromosomal abnormalities. These should be watched for, but that’s usually something an ordinary obstetrician or midwife can do. Unless the complications you’re at higher risk for actually develop, your pregnancy-related medical visits are likely to be wonderfully “normal” compared with what you went through during cancer treatment!
5. I’ve been unable to get pregnant after cancer. Is my dream of having a family (or having more kids) over?
No way. There are many other options for having children if you are unable to get pregnant after cancer. We adopted our wonderful daughter in domestic infant open adoption, and many U.S. adoption agencies welcome cancer survivors. (You’ll just need a letter from your physician stating that you have been successfully treated for your cancer and that he or she sees no reason why you wouldn’t be able to parent a child.)
There’s also foster parenting, surrogacy, egg donation, and embryo adoption, all of which are possibilities for cancer survivors.
There is one essential message for every cancer survivor: If you have love to give a child, there’s a way for you to become a parent. It might not be as easy as you thought it would be when you were younger. It might be more expensive, more difficult and more frustrating, especially when it seems so easy for so many of your friends. But it can be done. And when you hold your child in your arms, it’s all worth it.