Fertility Decisions Before Cancer Treatment: Evan’s Story

A diagnosis of cancer or another serious illness can make life feel as if it has been turned upside down. There are many emotions to manage and important decisions to make. One topic that sometimes gets overlooked is fertility preservation.

What is fertility preservation?

Fertility preservation means taking action to save or protect eggs or sperm before treatments such as chemotherapy or radiation, which can sometimes affect the ability to have children later in life. Not every treatment affects fertility. But some can, so it is important to talk to your care team about the risks and options.

Kari Bjornard, MD, director of the Preservation of Reproductive Health program at St. Jude Children’s Research Hospital, explains that the first step is understanding your diagnosis and treatment plan. Some treatments are more likely to affect fertility than others. For example, radiation to the pelvis or certain chemotherapy drugs can have more risk.

Your age and development stage may also matter. Different options are available depending on whether you have gone through puberty.

Facing cancer and fertility decisions

Evan Moore was 20 years old when he was diagnosed with cancer. A college student and athlete, he did not have many symptoms at first. He did notice that his performance in track and cross country was suffering.

A hamstring injury would not heal. Moore also had a swollen lymph node in his neck. Originally, tests came back normal, but later the care team discovered that Moore had Hodgkin lymphoma.

Moore took a break from his college teams at Lee University during treatment. Now he is back in college and running again. He is studying health science at Lee.  

Moore and his family had known someone who had gone through cancer. So, they were aware that treatments could affect fertility. His mom brought up fertility preservation almost right away. Together, they decided to talk to the care team about his options before starting treatment.

“I had thought about it, but it wasn’t the first thing I was thinking through,” Moore says. “It was something my mom and I had a very good open conversation about early on in my diagnosis.”

What are the options?

For boys and young men who have gone through puberty, the main option is sperm banking. It involves collecting and freezing sperm for future use. This process can usually be done quickly—sometimes within 1 or 2 days.

The process can be more complex for girls and young women and may take up to 2 weeks. It usually involves taking medicines to help the ovaries release eggs, which are then collected and frozen.

There are newer, experimental options for children who have not yet reached puberty, but not every hospital offers these methods.

Sometimes, there is not enough time to do fertility preservation before treatment must begin, or the patient may be too sick to go through the fertility preservation process. Every situation is different. Your care team will help you understand what is possible.

Talking about fertility  

Talking about fertility can feel awkward, especially when dealing with a serious illness. Moore shared that it was a bit uncomfortable at first, especially talking through it with his girlfriend (now fiancée). But he found that being open made things easier.

“It is hard, but it is better after you have those conversations with the people that you love,” Moore says. “Remove the awkwardness from it, put everything else to the side, and really focus on your future—what's best for you and your health.”

Bjornard adds that there is no “one-size-fits-all” answer. Some families may have cultural or religious beliefs that affect their decisions. Sometimes, parents and children do not agree. In these cases, it helps if everyone can get the same information from the care team and talk openly about their thoughts and feelings. Sometimes, a counselor, chaplain, or another trusted adult can help.

When to speak up

If your medical care team does not bring up fertility preservation, it is OK to ask.

Bjornard suggests saying something like, “I heard that some cancer treatments might affect the ability to have children in the future. Can you tell me more about that?”

Even if your doctor does not have all the answers, they can connect you with someone who does.

Many paths to building a family

It is important to know that there are many ways to become a parent. Even if your fertility is affected by illness or treatment, options like adoption, sperm or egg donation, or embryo adoption can help you build a family. And medical technology continues to improve every year.

“For me, being a parent is about being a mentor and a loving leader,” Moore says, “whether that is to my own children, adopted children, or even as an uncle.”

A continuing conversation

Bjornard reminds families that fertility conversations do not have to happen just once. As patients grow up and move through treatment, it is wise to revisit the topic and ask new questions.

Moore’s advice is simple.

“Try to stay positive, be with the people you love, and have open conversations,” he says. “It is hard to do this alone. Talk to your doctors, your family, your friends. You don’t have to go through it by yourself.”

Every family’s journey is unique. If you have questions about fertility and your treatment, ask your care team. They want to help you understand your options and support you along the way.

Season 3 of Caregivers SHARE, a St. Jude Podcast, features Evan Moore. Listen to the podcast episode below.