Cancer Treatment: The Fertile Question

Everyone knows that breast cancer treatment is no fun. Not only must a woman grapple with a life-threatening illness, she could have one or both breasts sliced off. Or she may be forced to undergo chemotherapy, which can result in baldness, among several other singularly nasty side effects. Even if the treatment’s successful, she may be rendered infertile since chemotherapy, pelvic radiation, and bone marrow transplants can affect fertility in both men and women. Medical advances have boosted survival rates but, especially for young women, to be permanently denied a choice to be a mother is an added horror.

Maryam with children at an orphanage in Zenica, Bosnia

Laudably, oncologists may offer fertility counselling, most often to women between 18 and 40. A young woman sits in a clinic where she’s forced to make harrowing decisions even before life-saving treatment can begin. Should she freeze her eggs? Frozen eggs alone have only a 10 per cent chance of producing a future pregnancy. She’s told it’s better to freeze an embryo. But to produce an embryo requires sperm. Does she have a partner? Not so easy a question if the woman is single, or in a new or uncommitted relationship. No partner? She can pick an anonymous sperm donor from a binder containing laminated biographies of potential fathers.

But even if she has a partner or chooses a donor should she go ahead with IVF at all? In vitro fertilization is a highly invasive procedure in which a woman’s ovaries are overstimulated to produce more eggs than they would normally, which may cause breast cancer to grow. IVF exacts a heavy financial toll. Each round of IVF costs between $15,000 and $20,000, and that’s only one round. A successful pregnancy may require several rounds. The physical and emotional costs of the quest to become pregnant are equally if not more agonizing, particularly on the woman. 

Maryam and children in Zenica

As a human rights activist who worked in Bosnian orphanages before I was diagnosed with breast cancer, I was appalled that my counselling never mentioned the possibility of Canadian or foreign adoption. Adoption, it’s true, can be expensive and complex. At the same time, it can be sublimely rewarding. To not even present it as an option for cancer survivors is reprehensible. Fertility clinics have the best of intentions, which doesn’t mean they unwittingly can’t be influenced by profit statements. And preserving a woman’s fertility is big business. 

In my personal case, I was doubly fortunate both in treatment and its outcome. At the beginning of my ordeal I possessed a tumour on my left breast the size of a tangerine. After much distress, I underwent a lumpectomy combined with radiation and chemotherapy. The excellent treatment I received brought about a full recovery. And, as it turned out, my fertility was not impaired. If I choose, I can bear a child. I did not have to select a generous sperm donor from a laminated binder. Nor did I need to bankrupt myself in the course of an indefinite series of IVF sessions.

Maryam and youth in Zenica

Surprisingly few young women diagnosed with cancer take steps to preserve their fertility. This, medical journals tell us, is due to the fact that fertility counselling is not as widespread as it should be. Even when it is available, the cancer patient’s potential inability to have a baby amounts to one more obsessive worry she doesn’t need in her life-or-death struggle. Counselling for young women facing cancer is indispensable and should be universally accessible. Such counselling should empower them with every possible choice in their ongoing lives. It should teach them that there are many different ways to start a family. Pregnancy is only one of them. The first medical imperative must always be to save women’s lives. The second should be not to handcuff women to their ovaries.

- Maryam Manteghi

Maryam Manteghi worked for United Nations organizations in postwar Bosnia. She teaches law at Seneca College.

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