Parenting: Preconception
Tracy Rasmussen of Pottstown, Pa., thought conceiving children was going to be a breeze, but Rasmussen and her husband began having fertility problems soon after trying to conceive. Eventually, it was determined that she had endometriosis.
"I thought I had a lot of time to conceive, so we tried some conventional therapies to shrink the endometriomas (the tumors associated with endometriosis) but it didn't work, so I was recommended for surgery," Rasmussen says. "The surgeon told me that he might have to do a hysterectomy if things looked really bad."
Though they didn't have to take her uterus or ovaries in that surgery, a second surgery took one of her ovaries and left the other one unable to function. Rasmussen had been sure that the second surgery was going to work, and once it became clear she wasn't going to be able to conceive on her own, she was devastated.
"I felt horrible," says Rasmussen, who is now the adoptive mother of twins. "I was depressed and cried a good deal of the time. I'm sure the hormonal imbalance caused by my very sudden and early menopause didn't help, but I was devastated."
Confronting the Unbelievable
There are many personal health tragedies that could potentially leave a woman unable to conceive. Lindsay Nohr Beck of New York, N.Y., was diagnosed with tongue cancer at the age of 22 and then again at 24. The second time, it spread to her lymph nodes, and aggressive treatment was needed. When Beck realized that the chemotherapy could leave her infertile, she was overwhelmed with loss.
"The potential of infertility was more devastating than my cancer diagnosis," Beck says. "Although life threatening, cancer was temporary and treatable. Infertility, on the other hand, was incurable and permanent. It had the potential to drastically change the rest of my life and in addition to cancer seemed unfair and impossible."
Beck cringed at the thought of being 24, single, infertile and a cancer survivor. She realized the only thing she had any control over was infertility, and she decided she couldn't sit back without taking precautionary fertility preservation measures. After much research, she found that freezing her unfertilized eggs (oocyte cryopreservation) was indeed an option. In spite of the expense and the added medical procedures to an already full schedule (radiation treatments, doctor appointments, etc.) Beck decided to go ahead with the procedure.
"Adding fertility preservation to the list was daunting, but I did not see it as a choice," says Beck.
Growing Hope
The experience was so lonely and isolating that Beck founded Fertile Hope as a support organization for those in similar circumstances. Fertile Hope is a national nonprofit organization dedicated to providing reproductive information, support and hope to cancer patients whose medical treatments present the risk of infertility.
"Many patients call us complaining about their friends, family and healthcare professionals' reactions to their concern over fertility," Beck says. "Many people feel like I did – it is worse than the cancer; however, their support network is telling them to be thankful they are alive and move on. It is hard not to be angry, overwhelmed and very isolated."
Radiation and chemotherapy are not the only health issues that can affect fertility. According to Dr. Mark Leondires, medical director of the Center for Advanced Reproductive Medicine in Connecticut, any operation of the abdomen runs the potential of damaging the very fragile fallopian tubes.
"This would include surgery for an appendix or ovarian cyst," Dr. Leondires says. "A pelvic infection in the past could damage the fallopian tubes, as well."
Any traumatic abdominal injury that led to peritonitis or bleeding in the abdomen could damage the fallopian tubes. Cancer with treatments such as chemotherapy or radiation therapy can also cause damage to the ovaries or fallopian tubes.
There are several different options for women that can be performed before fertility-endangering procedures or treatments. Which procedure you choose depends on many factors, and you should speak to your medical team and fertility experts to help you choose the one that is best for your situation.
- Embryo Freezing: Mature or immature eggs are removed, fertilized using standard in vitro fertilization (IVF) techniques, frozen and stored.
Egg Freezing: Mature eggs are removed, frozen without being fertilized with sperm and stored. Stimulation options are similar to those noted above for embryo freezing. This procedure is still in the experimental stages. Dr. Leondires says that while there is limited data on the success from freezing eggs and or ovarian tissue, there are many excellent researchers working on this.
- Ovarian Tissue Freezing: The ovary or ovaries are removed laparoscopically, divided into small strips, frozen and stored for later transplantation back into the woman's body or used for in vitro maturation.
- Ovarian Transposition: Ovaries surgically moved away from the radiation field to minimize exposure and damage. Ovarian function success rates are approximately 50 percent.
There are many options for women who are facing possible infertility due to personal health issues. Technology, however, comes with a price. These procedures are often prohibitively expensive, and many people find that insurance companies rarely cover them. Yet, Beck and many other women are finding the peace of mind that comes from dealing with possible infertility ahead of time is priceless.
