Facing Unexpected Fertility Decisions after My Cancer Diagnosis

One of the most unrecognized impacts of cancer and its treatment is how it can affect your chance to have a family.

Likewise, having to make rushed decisions about fertility preservation pre-treatment can feel traumatizing alongside everything else you’re coping with. Alice May-Purkiss shares her story.

Being diagnosed with cancer is a curveball at any age, but being diagnosed with cancer in your 20s is a real doozy. When you’re supposed to be Living Your Best Life™, you suddenly find yourself swapping cocktails for cancer treatments, promotions for a prognosis... and, perhaps most unexpectedly, festivals for fertility preservation. 

One of the most unrecognized impacts of cancer is how it can affect your chance to have a family. And when you're diagnosed at a younger age, the ripple effect of this can be massive.

I was 26 when I was diagnosed with breast cancer. When my healthcare team said that I'd need to think about protecting my possibility of having children in the future, I was baffled. On an average day, I had trouble figuring out what I wanted for lunch. Now, I had to decide whether to opt for extra medical procedures on top of my future cancer treatments.

I wasn’t sure about children or anything else – only that I wanted to survive

At this point, I'd been with my then-boyfriend (now husband) for nine years. We were "teenhood" sweethearts. But I didn't know whether we'd make it through the devastation of a cancer diagnosis. How could I? We were as solid as we could be, but cancer puts an enormous strain on relationships. Not to mention the fact I'd always said I didn't want kids.

I was trying to concentrate on what I needed to do to survive. But now I was being told to think about some possible idea of a future, which at that point seemed out of reach. It was a lot to process. Eventually, I decided to protect that future I could hardly even imagine. I'd try the fertility preservation treatment. But it was far from straightforward.

Hearing that cancer treatment may impact your fertility may be the last thing on your mind when you're thinking about the business of staying alive. Or it might be downright devastating.

I had no idea cancer treatment could impact my fertility. To make things trickier, the way it does depends on the cancer type and treatment, so I can't speak for every young cancer patient. For me, the fact I had to add another thing to my "Cancer To Do List" was mind-boggling.

I was lucky enough to have access to fertility treatment. I now have an "insurance plan" should I not be able to conceive in the future - if that's something I decide I want. But it isn't available to everyone.

For many patients, fertility preservation isn’t obstacle-free

For some, cancer treatment needs to happen quickly, so creating a backup fertility plan isn't an option. For others, it doesn't happen because those services aren't available in their area.

In the UK, those from the LGBTQ+ community may face extra (and more triggering) challenges when making decisions about preserving their fertility. Freelance journalist Dean Eastmond was 20 years old when he was diagnosed with Ewing's Sarcoma - a form of bone and soft tissue cancer – in 2016. Like me, Dean came from the UK, and he relied on the National Health Service (NHS) for medical attention and treatment. Dean was told that if he died, his partner wouldn't be able to use his frozen sperm sample with a surrogate, as he and Dean were in a same-sex relationship.

Despite his diagnosis, Dean set about getting the policy changed. He worked with Buzzfeed UK to expose the outdated legislation, winning an apology from the Human Fertilisation and Embryology Authority (HFEA). Shortly afterward, the HFEA confirmed that the process for same-sex and heterosexual couples would be the same.

Dean passed away in 2017, but his campaigning meant others like him wouldn't be discriminated against in the same way. He created much-needed change around equal fertility rights for gay men and LGBTQ+ training for staff in cancer wards. Dean was a game changer for many people - in the LGBTQ+ community, but for single and married people, too.

Meanwhile, according to an ABC News article on access to fertility treatment for LGBTQ+ couples, countless same-sex partnerships in the US are fighting for “fertility equality.” Out of the 14 states that provide insurance plans for fertility healthcare, only three states have insurance laws that cover LGBTQ+. Advocates for fertility equality in the US say that LGBTQ+ couples face obstacles that aren’t there for heterosexual partners.

Many of us feel that fertility issues with cancer treatment aren't talked about enough

Feelings about fertility can change over time. Whether you want children or don't, feelings around the subject can be complex. When you're told you may not be able to have children so early on in life, it can have a massive impact on your mental health. I speak to tons of young people diagnosed with cancer in their teens, 20s, or 30s for my podcast AfterThoughts. One thing we all have in common is bearing the massive weight, mentally and physically, of this too-little-discussed treatment side effect.

AfterThoughts guest Miranda Ashitey, like Dean, faced hurdles with fertility treatment in the UK. In this case, it was because she was single. While Miranda would be able to have her eggs frozen, she was told they'd be more viable fertile, so she'd have to pay privately for a sperm donor. Then, if she decided to use her eggs later on, she'd have to pay to have them unfrozen – something married patients don't need to do.

Weighed down by this massive (and expensive) decision, Miranda’s choice was taken away at her next appointment. Time wasn’t on her side – she needed cancer treatment as soon as possible.

For those who do have a bit of time, some feel like being asked to make this decision on top of everything else is wrong and unfair. Others feel like it's an impossible ask at an already overwhelming time. For many, it feels like one trauma is being piled on top of another.

When you're diagnosed with cancer, you often have to make decisions at speed – as was the case with my fellow Life Effects contributor, Anna Crollman. It can feel like there's no time to process everything - like it's all dizzying and has come much earlier than it should have. We've been pushed to make "grown-up decisions" long before we feel like actual grown-ups.

I’m relieved that I chose a “fertility backup plan” now I’ve finished my cancer treatment

I'm 34 now. It's been eight years since my cancer diagnosis. I still don't know if I want kids. But I'm glad I have the option, whatever my treatment has done to my fertility. I'm grateful to my past self for making the hard decision to protect a future she didn't know she'd want - even if I still don't know whether I want it. I'm grateful for all the needles and the extra treatment I put myself through. I'm glad my hospital gave me the option.

It's a relief to have a backup plan. When 26-year-old me received a cancer diagnosis, the "extra" news that I'd have to worry about my fertility shook me to the core. My "insurance" is a big deal to someone like me, who faced infertility alongside a life-threatening diagnosis.

I hold out hope that everyone who's in the position I was then can access the same opportunities. Having that choice matters more than I ever could have imagined.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence, or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.

NPS-ALL-NP-01134 NOVEMBER 2023