Fertility issues, planning the future, and your young family...

DR. MICHAEL (medical oncologist): When deciding whether to have children after cancer, there are separate issues to be considered. First, what is the likely outcome of the cancer itself? Second, is there any risk involved in getting pregnant with this particular type of cancer? And of course, the couple has to consider the possibility that the child may lose a parent if the cancer comes back.

KRISTIN: My doctors decided that I should have the most aggressive chemotherapy. I was willing to do it, until they told me I had a fifty-fifty chance of losing my fertility. My husband and I were just trying to start a family. When I heard I might lose my fertility, I panicked and had a knock-down-drag-out fight with my oncologist. I told him that if he couldn't give me anything better than a fifty/fifty chance of ending up fertile, I didn't want to do it. Then he said to me, "Do you want to have children or do you want to die?" I said right back, "Don't threaten me."

Dr. ANNA WU, Ph.D. (researcher, survivor): When I was diagnosed with breast cancer at the age of thirty-three, my husband Jeff and I were just starting out. We finally had "real" jobs, we had been married not quite three years, we had a twenty-one-month-old daughter, Lizzie, and cancer was the furthest thing from our minds. The diagnosis brought all our plans to a screeching halt. And issues of family rose to the forefront. The immediate concern was would I get sick, would I die, would I have to leave my husband and this little girl behind? And all the thoughts of adding to the family went right out the window. AT one point we had the passing thought that we could adopt. Then I came to my sense; who would let a cancer patient adopt a kid if you weren't sure she'd be there to raise it? We place our lives on hold.

Fortunately the days, weeks, months went by, and no more bad new rolled in. The issue of having another child continued to swirl and solidify. I searched the medical literature and found next to nothing of use. I questioned my doctors, who were quite supportive; they just wanted me to wait a couple of years. In truth, if I really was cured, there was no reason not to have another kid. But when do you know you're cured? And Jeff and I had many long talks. My greatest fear was that since my tumor had been estrogen-receptor positive, if I became pregnant and my body was flooded with hormones, any lurking cancer cells would burst forth and grow wildly. And was it fair to have another kid if you didn't know you would be there for the child in the future?

As time passed, more positive thoughts replaced the fears. We already had one child, and we felt that it was important to have a sibling; siblings share a special bond. We knew that despite our best intentions, no parent can guarantee to be there forever for the children. Whether it be cancer, other illness, accidents, or divorce, life has many unexpected ways to alter plans. And finally we came to a place where we decided that no matter what happened to me, having another child was something we wanted to do as a family. And so, a year and a half after being diagnosed with cancer, I became pregnant.

The day that Kelsey was born was indescribably wonderful. For months after diagnosis I had been depressed by thoughts that my body had betrayed me, that something within me was trying to kill me. Now I held in my arms living proof that something good could still come of my body. Having Kelsey allowed me to reclaim my physical self. She was my "get well" present to myself. Even now, I never feel more alive than when I hold her close and feel her heart beat next to mine. Looking back, having a baby was the best thing to do to help me move beyond cancer.
It was such a good experience that three years later we had Jeremy!

ROBIN: My husband and I decided that regardless of what happened, a family was really, really important to us. We have one child, a daughter, and feel that a sibling is very important, that our family wouldn't be complete without another child. We're concerned that another pregnancy might cause the cancer to recur, but I want to leave another piece of myself behind. And even if I die, I will live through my children.

TERI: I was very nervous because I also had an estrogen-receptor positive tumor. I was worried that being pregnant and flooding my body with hormones might cause something terrible to happen. It was a very nerve-racking experience. But my husband and I wanted to do it.

ALLISON: I think initially everyone was primarily concerned about my survival. But my husband and I decided that we were going to have this baby. There are no guarantees in any pregnancy.

KIMBERLY: When I was first diagnosed I was about three months pregnant, so the doctors advised me to get an abortion. Obviously, that was a very traumatic time, but my faith enabled me to persist and to seek further opinions and treatment, and I did give birth. We're both doing fine, thank God.

DR. MICHAEL (medical oncologist): I'm so happy to hear that you had what it took to get another opinion when the doctor said you had to lose the child. Most of the time, today, cancer treatments can be applied during pregnancy. What's remarkable is that once you get into the second and third trimester, you can actually undergo chemotherapy.

CARLA: I was diagnosed with breast cancer when I was eighteen weeks pregnant, so Kimberly and I share the joy of having miracle babies. I went through two surgeries and had chemo during my pregnancy. I went full term and now have a beautiful, healthy four-month-old baby.

DR. MICHAEL (medical oncologist): A fair number of women have conceived babies while they were receiving chemotherapy. It doesn't seem to affect the egg itself, except on rare occasions.

CRYSTAL: I was twenty-three when I was diagnosed with lymphoma. My oncologist decided to treat it very aggressively and he pretty much told me I would be sterile after my chemotherapy. It was very sad, but my first concern was living. My mother had died of breast cancer when I was a small child, and everyone I had known who had cancer ended up dying, so I had no role model. My hopes weren't too high, so the idea that I wouldn't have children didn't really hit me too hard right off the bat. I just assumed I was sterile until several months ago, when I thought I had a kidney infection and went to the doctor. He did some tests and found out that I'm pregnant.

KATE: Eight years ago, I was diagnosed with non-Hodgkin's lymphoma. I was twenty-five, didn't have a significant other in my life, and had just finished college. I went from getting my degree to getting chemotherapy. My treatment was pretty difficult. I wound up with heart problems, and was told that I would probably never be able to have children. At the time, I wondered how I was ever going to have someone important in my life. And now, eight year later, I'm married, have a three-month-old child, and things are great.

MIA: When I learned I had cancer, I felt my body had betrayed me. It changed the way I saw the world. But then, to be able to give birth to my second son three years later was the most positive thing I could have done. It helped me focus on the future. It helped me regain some comfort with my body to know that something so good could come out of it. I think about recurrence less and less. Although I know it's a possibility. Instead, I focus on my children, in the present and in the future.

CLAUDE: My wife and I already had one child when they told me that I would be sterile because of my cancer. There were no "ifs," "ands" or "buts" about it. At my doctor's suggestion, I went down to the sperm bank and banked my sperm so we could have children later. I was very grateful that I'd been told about that. It would have been devastating to know that I could never have any more children.

URI: I'm eighteen years old. It was really weird but I went, shall we say, to make my deposit at the sperm bank. Even though it was a clinical experience, it also felt like an affirmation of life, a way of saying that there will be a future.

DR. MICHAEL (medical oncologist): Although many of the chemotherapy programs do not cause permanent infertility in men, I always advise my male patients to freeze some sperm. It's a good safety precaution.

MARC: When I was diagnosed with testicular cancer at nineteen, my urologist didn't tell me I could store away sperm. After all the chemo I received, wee, there was nothing there anymore and I realized I'd never be able to father a child. I still feel angry that my doctor never told me about banking sperm to protect my future fertility. He told me afterward that he didn't tell me because he thought I was too expensive for me, that he didn't think I would be thinking about children at age nineteen. I'm now twenty-nine and engaged to be married, but I'm dealing with feelings of loss and regret.

ANNE: I have a twenty-eight-year-old son who had cancer when he was eighteen-a rhabdomyosarcoma-and he had extensive radiation and potent chemotherapy. The first thing they told us was that he had a good chance of being sterile after the treatments.

DR. MICHAEL (medical oncologist): The chances of him being at least temporarily sterile are very high. Most men of that age eventually recover their fertility, even if they have had intensive kinds of chemotherapy. He could be tested for fertility. The test is simple. And the chances are pretty good that he is fertile, so he ought to be careful.

ANNE: Well they did, but he was eighteen when this happened. He was in his first year of college, and we did talk about it, but he never availed himself of the opportunity. I guess he was embarrassed. And he never mentions his condition now, even with his girlfriend.

PERRY (oncology social worker): Denial works in some cases-at least for a while-and it's understandable. It's not unlike a lot of young men to simply pretend it didn't happen. It would help him to talk to somebody about what he's going through, especially if he is involved with a woman. There are groups of young men, designed for young men, that handle this.

ANNE: But he won't have anything to do with it. He's stoic, he doesn't want to discuss it. One of the ways he got through this whole ordeal with such dignity was through denial, although he never missed a treatment. And they were five days a week for a year and a half.

PERRY (oncology social worker): He did what he needed to do in order to survive that period. Now he should come to understand that he doesn't need to do that any longer. What worked for him in the beginning can be discarded, because conditions and goals have changed.

Young adults who are married with children have additional stresses. If they are financially responsible for a young family, a diagnosis can destroy economic stability and any sense of safety, just as it creates emotional trauma. Parents sometimes try to protect their kids from knowing that Mom or Dad is sick, but children know when something is wrong. Communicating with your children can reduce their fear and make them feel that they can help in some way. Many doctors will encourage parents to bring their children in for an office visit in order to help them understand and demystify what's happening.

NEIL: My son was really young when I was diagnosed. But he knew something was going on, because on the days I got chemotherapy he would spend the night at his grandparents' house. Everyone said he didn't really know what was going on, but he knew Daddy didn't feel good. I'm sure he wondered, "Is Daddy going to get better?" We explained it to him. At first we just said, "Daddy's sick." But when he turned three we started to tell him, "Daddy has cancer and this is what he has to go through." My wife was very helpful and explained a lot more about it, because a lot of the time I was too sick to explain it well. But it was tough for him. It was really hard on him.

HALINA (therapist): We need to tell children what is happening, because even the youngest will sense there is something wrong. If it's not explained, they'll believe that it's such a terrible thing that it can't be talked about. It's important to talk about it, to reassure children of all ages that there will always be somebody there to love them and take care of them. It's also vital to let them know that the parent's illness is not their fault.

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