Planning a family post-cancer can be a complicated process if a patient’s fertility was compromised during their cancer treatment. Depending on a cancer survivor’s prior treatment regime and subsequent fertility options, a number of family planning options may be available to them. I spoke with Angela Lawson, PhD, a Psychologist at Northwestern Memorial Hospital in the department of Reproductive Endocrinology to learn more about what reproductive options are available to cancer patients who have been left infertile as a result of their cancer or cancer treatment.
One option for women who have banked eggs prior to cancer treatment or whose ovaries are still intact, but do not have a functioning uterus, is to use a gestational carrier. A gestational carrier or surrogate is implanted with an embryo, to which she may or may not have a genetic relationship with, and then carries the fetus to term. Once the baby is born, he/she is then legally placed with the intended parents where they then sign their names on his/her birth certificate.
Individuals can either go through an agency to find a gestational carrier or they can choose someone they know, possibly a friend or family member. Going through an agency can cost upwards of $100,000 with costs to the carrier, the agency, insurance and IVF to stimulate egg production. Going with someone you know is less costly and often makes people more comfortable knowing they have a personal relationship with the carrier that precedes the surrogacy. Personal relationships can lead to more emotional implications - the surrogate should feel comfortable giving the child to the intended parents knowing they will remain in the periphery of his/her life. Check out our blog, Delivering Hope, to learn more about one family’s incredible experience with surrogacy.
An option available to women who do not have the use of their own eggs, but can carry a fetus, is egg donation, whereby the cancer survivor follows a similar selection process as they would if they used a gestational carrier. Often, the medical community prefers the recipient use an anonymous donor rather than use donor eggs from someone they have a personal relationship with. This prevents complications that can arise in the event that the egg donor experiences any complications later in life which may impact her fertility before she has the opportunity to parent a child. If using an agency, egg donation is currently entirely anonymous.
All potential gestational carriers and egg donors go through a rigorous medical and psychological screening to ensure that they are being honest about themselves, to ensure they are stable and that they are not at risk for emotional vulnerability which can pose problems once the child is born. According to Dr. Lawson, about 50-75% of surrogacy and egg donor arrangements make it through the screening and move forward with the process.
If egg donation and surrogacy are off the table, adoption is always a great option too. Having a history of cancer can make the process a little more challenging as not all agencies will adopt to cancer survivors. Sometimes either the agency or the birth parents are concerned about cancer recurrence and the subsequent repercussions to the adoptive child. Bearing this in mind, the Oncofertility Consortium compiled a list of cancer-friendly adoption agencies for survivors interested in navigating this option.
For more information on your reproductive options post-cancer, please contact our Fertility Preservation Patient Navigator, Kristin Smith, to learn more about resources in your area.