Planning ahead for fertility when you have a brain tumor

A painful fact about brain tumors is that they can strike people of any age or gender—and so that includes young women who may someday want to have families. Even worse: the often-necessary treatments for malignant brain tumors, radiation and chemotherapy, can impair fertility.

Yet despite this being a concern for many young women, all too often, patients of reproductive age say they have no recollection of any discussion about the impact their treatment could have on their ability to have a family.

It’s important to note that women who are treated for brain tumors become mothers all the time. If becoming a mother is important to you, there is a very good chance that it’s possible, especially with clear planning and a lot of openness with your doctors about your priorities.

Different stages of treatment call for different approaches. Your life-stage and whether you have a long-term partner may also have an impact on these discussions.

Before treatment

If possible, the best time to discuss fertility plans is with your doctors, before starting treatment. This is true even if children are only a distant possibility at this point in your life because prior to starting treatment is when you have the widest variety of options. Ideally your doctors will bring this up themselves. If they don’t, it is a great topic to add to your list of questions to ask your doctor. They may refer you to a fertility specialist to explore your options.

Embryo Freezing

This is an effective method for patients who are married or are willing to use donor sperm. Eggs are harvested and fertilized in a lab with sperm (a.k.a. “in vitro fertilization” or “IVF”). They are then frozen and stored. Later, when the woman wants to become pregnant, one or two frozen embryos may be implanted during any one cycle. The initial harvesting takes between 2 and 6 weeks and some doctors may be willing to delay chemotherapy to complete the process.

Egg Freezing

For patients who are unmarried or don’t want to use donated sperm, this method can be effective. Eggs are harvested and frozen. When the woman wants to become pregnant, eggs are thawed, fertilized with donor sperm (IVF) and implanted. Pregnancy rates are lower with egg freezing than with embryo freezing, because the freezing process is more likely to damage unfertilized eggs than embryos. The initial harvesting takes between 2 and 6 weeks and some doctors may be willing to delay chemotherapy to complete the process.

Ovarian Tissue Harvesting

This is an experimental approach that might be an option for women who cannot spare the 2-6 weeks for egg harvesting. A portion of tissue is harvested from the ovaries and frozen. Should treatment damage ovaries and cause eggs to stop maturing, the frozen tissue may be re-implanted after treatment ends. This can help restart egg production.

Ovarian Suppression

This is another experimental option. Ovaries are shut down during treatment with a monthly injection, which lower the risk of them getting damaged by chemotherapy. After treatment, the injections are ceased, the ovaries “wake up,” and there may be better chances for a full-term pregnancy.

After Treatment

If cancer treatment impacted your fertility, there may still be options for starting a family. You can talk to a fertility specialist to explore specific options as well as your neuro-oncologist and primary care physician to determine what is safe for you.

Egg Donation

If your eggs have been damaged, you may be able to use eggs donated from another woman. The eggs would be fertilized via IVF and then implanted in your uterus to carry to term.

Surrogacy

If you have usable eggs or embryos but you are physically unable to carry a child, or it would be too great a health risk, you may be able to use a surrogate. Your eggs would be fertilized via IVF and then implanted in the surrogate’s uterus to carry to term.

Adoption

It is possible for cancer survivors to adopt. However, state laws or adoption agencies may impose additional requirements, such as providing your medical records or waiting a period of time after the completion of treatment before being allowed to adopt. A social worker or an adoption attorney may be able to help you navigate the requirements.

Pediatric Patients

Parents of young women and girls who are being treated for cancer have special considerations all their own to make. For girls who haven’t yet experienced puberty, their families will often have to be proactive in bringing up future fertility options with doctors, because it’s even more rare in these cases for doctors to bring it up. The Children’s Hospital of Philadelphia offers this helpful introductory video about fertility preservation for younger women and girls being treated for cancer.

Resources

National Cancer Institute – Fertility Issues in Girls and Women with Cancer
Cleveland Clinic – Cancer and Fertility
Mayo Clinic – Fertility preservation
MD Anderson – Fertility and Cancer: 10 things to know
National Cancer Society – How Cancer Treatments Can Affect Fertility in Women

Scientific Literature

The Fertility-Related Treatment Choices of Cancer Patients: Cancer-Related Infertility and Family Dynamics
American Society of Clinical Oncology recommendations on fertility preservation in cancer patients