No matter your age, a cancer diagnosis is an alarming experience and can raise a lot of questions about your health and future.
Dr. Umangi Patel walks listeners through how a cancer diagnosis and treatment can affect fertility.
Fertility & Cancer
Featured Speaker:
University and completed her residency in Internal Medicine at Catholic Medical Center of Brooklyn and Queens. She is fellowship trained in Hematology and Oncology, serving at Long Island Jewish Medical Center.
Umangi Patel, MD
Dr. Umangi Patel is board certified in Internal Medicine, Medical Oncology, and Hematology. She is the current Medical Director of St. Luke’s Cornwall Hospital Oncology Services. Dr. Patel received her medical degree from N.H.L. Municipal Medical College GujaratUniversity and completed her residency in Internal Medicine at Catholic Medical Center of Brooklyn and Queens. She is fellowship trained in Hematology and Oncology, serving at Long Island Jewish Medical Center.
Transcription:
Fertility & Cancer
Melanie Cole (Host): If you've been diagnosed with cancer you know that's like something that blows your mind. You don't expect it especially if you're a younger person. Right away you might not think of this, but as the long-term treatment goes on you might think, "Wow, can I still get pregnant?" Fertility issues start to come top of mind. My guest today is Dr. Umangi Patel. She's the Medical Director of Saint Luke's Cornwall Hospital's Oncology Services. Dr. Patel, when we think about fertility preservation, people don't always right away think about cancer. Tell us what it is and how it's used for people that have been diagnosed with cancer.
Dr. Umangi Patel (Guest): Oncofertility is the term that we use. As we know, the incidence of cancer is increasing in young adolescents and adults. When they are faced with this, the last thing they have on their mind is the preservation of fertility. They are in the mode of treatment and survival. With advances in treatment, these patients are surviving, and many of them are in remission and cured, and hence, they need to get back to their normal life. At that point, when they are thinking about fertility, it's kind of too late. For all patients that are diagnosed to have cancer and are going to consider cancer treatment, they should be thinking of preservation of their fertility. The physician should discuss that up front along with the initial management plan with the patient.
Host: You said a physician should discuss that up front? If the physician doesn't because they are more concerned as well with treatment, at what point should this be discussed? Should the patient be an advocate and bring this up for themselves? When should a fertility specialist be brought into that discussion?
Dr. Patel: Either the physician or the patient should say something at the time of initial evaluation, and planning of the treatment and fertility preservation should be considered, and be offered, and be done prior to starting therapy — whether it is surgery, whether it is radiation, whether it is chemotherapy. Whether the patient brings it up as their own advocate or the physician brings it up, once they plan out the treatment they should bring the fertility specialist as well as a Reproductive Endocrinologist ahead of the time. Prior to starting treatment they all should be brought in as a part of the care given.
Host: That's really important information, Dr. Patel, that people might not think about. What about if a child has cancer — because a newly burgeoning field of medicine along with Oncofertility preservation is this type of preservation for children that maybe haven't even gone through puberty or are just starting puberty — speak about Oncofertility preservation in children a little. Is that something that we discuss as well?
Dr. Patel: Yes, that should be discussed with the parents. I'm not a pediatric oncologist, but I have to say that prepubertal preservation of fertility in young bodies is still an investigational approach for stem cell transplant for males, whereas for female prepubertal the ovarian tissue can be frozen and can be later on utilized. For prepubertal, young females it is still possible to preserve fertility. A Pediatric Oncologist should discuss that with the parents and bring in the fertility specialist as well as a Reproductive Endocrinologist as a part of the team.
Host: Tell us about some of the available options. People are concerned about their cancer treatment when a Reproductive Endocrinologist and the Oncofertility specialists are brought in, tell us what treatment options are even out there for fertility preservation.
Dr. Patel: For fertility preservation for males it would be sperm banking and cryopreservation of sperm. Sometimes there is not enough sperm, or they are unable to collect, so then microvascular surgical techniques are utilized to extract sperm directly from the testicle. That is for the males. For females, there is the preservation of the eggs. Eggs are frozen. Or, if the couple is already prepared, then they can freeze the embryo or the ovarian tissue of a female can be frozen. There are multiple options available for female patients that depends upon where they are in the stage of their life they can choose.
Host: Does any of this affect how well the cancer treatment works? As the treatment goes on and after treatment, Dr. Patel, how does somebody know if their fertility has been affected?
Dr. Patel: In terms of freezing ovarian tissue or in terms of freezing eggs and embryos, depending upon the cycle and depending upon the hormones that have to be given there may be one to three weeks delay before the treatment gets started. However, that should not affect the overall outcome of the majority of cancer patients. As far as the after-effects of the treatment it depends on what type of cancer, what type of treatment, and in terms of chemotherapy, what dose it is, what side effects, what cycles and the type of drugs that are utilized determine whether these patients will ever have fertility on their own at a future date or not.
The age of the patient also matters. Younger patients that are younger than 35 or even younger than 30 and able to regain their period and even fertility. Patients that are 40 and above are less likely to regain their periods and may undergo menopause. In those patients, the after-effects of premature menopause such as skin dryness, and hair loss, and cognitive function, and bone health, and vaginal dryness, and all of that are there for which they are referred to their Gynecologist for management of after-effects of premature menopause. Did that answer your question?
Host: You absolutely did. Dr. Patel, this is so informative. If somebody has tried one of those options for fertility preservation and they get told that their cancer is in remission or that they don't have it anymore have you seen with your patients that they're scared to then try whatever fertility treatments and preservation that they've used to try to get pregnant for fear that maybe their cancer might come back? What are some of the fears? What have you seen? What have patients told you?
Dr. Patel: The patients, especially breast cancer patients, they have cancers that if they were to now try for pregnancy and family planning, then the hormones that are needed would then increase their risk for recurrence. Generally, it is not true. We advise patients to at least wait for a year and then plan. In other patients, generally, hormone treatment is not considered as a risk factor for planning pregnancy and having a recurrence of cancer. I would say that I encourage my patients once again to maybe visit a fertility specialist and Ob/Gyn person, but I tell them they can absolutely go ahead and plan for a family if they are in remission.
Host: It's great information. Wrap it up, please. Your best advice for people or someone who knows someone has a loved one who might have been diagnosed with cancer but is still young enough to want to have children. What would you tell them about the importance of exploring their treatment options and being a good advocate and finding out what available options are out there for fertility preservation?
Dr. Patel: The best advice is that fertility preservation is absolutely available to all patients who are young adolescents and adults and should be discussed with the primary managing Oncologist. All of these patients should see fertility specialists and Reproductive Endocrinologists because often times they are scared. Often times they are afraid of outcomes of cancer itself and are not addressing this. Later on, it is sometimes not possible. Therefore, it is better to address this upfront before starting the actual management of cancer.
Host: That's great information, Dr. Patel. Thank you so much for joining us today and for sharing your expertise on this topic that may be sensitive to discuss, and not everybody is really willing to ask those questions. Thank you so much for coming on with us today. This is Doc Talk presented by Saint Luke's Cornwall Hospital. For more information, please visit SaintLukesCornwallHospital.org, that's SaintLukesCornwallHospital.org. I'm Melanie Cole. Thanks for tuning in.
Fertility & Cancer
Melanie Cole (Host): If you've been diagnosed with cancer you know that's like something that blows your mind. You don't expect it especially if you're a younger person. Right away you might not think of this, but as the long-term treatment goes on you might think, "Wow, can I still get pregnant?" Fertility issues start to come top of mind. My guest today is Dr. Umangi Patel. She's the Medical Director of Saint Luke's Cornwall Hospital's Oncology Services. Dr. Patel, when we think about fertility preservation, people don't always right away think about cancer. Tell us what it is and how it's used for people that have been diagnosed with cancer.
Dr. Umangi Patel (Guest): Oncofertility is the term that we use. As we know, the incidence of cancer is increasing in young adolescents and adults. When they are faced with this, the last thing they have on their mind is the preservation of fertility. They are in the mode of treatment and survival. With advances in treatment, these patients are surviving, and many of them are in remission and cured, and hence, they need to get back to their normal life. At that point, when they are thinking about fertility, it's kind of too late. For all patients that are diagnosed to have cancer and are going to consider cancer treatment, they should be thinking of preservation of their fertility. The physician should discuss that up front along with the initial management plan with the patient.
Host: You said a physician should discuss that up front? If the physician doesn't because they are more concerned as well with treatment, at what point should this be discussed? Should the patient be an advocate and bring this up for themselves? When should a fertility specialist be brought into that discussion?
Dr. Patel: Either the physician or the patient should say something at the time of initial evaluation, and planning of the treatment and fertility preservation should be considered, and be offered, and be done prior to starting therapy — whether it is surgery, whether it is radiation, whether it is chemotherapy. Whether the patient brings it up as their own advocate or the physician brings it up, once they plan out the treatment they should bring the fertility specialist as well as a Reproductive Endocrinologist ahead of the time. Prior to starting treatment they all should be brought in as a part of the care given.
Host: That's really important information, Dr. Patel, that people might not think about. What about if a child has cancer — because a newly burgeoning field of medicine along with Oncofertility preservation is this type of preservation for children that maybe haven't even gone through puberty or are just starting puberty — speak about Oncofertility preservation in children a little. Is that something that we discuss as well?
Dr. Patel: Yes, that should be discussed with the parents. I'm not a pediatric oncologist, but I have to say that prepubertal preservation of fertility in young bodies is still an investigational approach for stem cell transplant for males, whereas for female prepubertal the ovarian tissue can be frozen and can be later on utilized. For prepubertal, young females it is still possible to preserve fertility. A Pediatric Oncologist should discuss that with the parents and bring in the fertility specialist as well as a Reproductive Endocrinologist as a part of the team.
Host: Tell us about some of the available options. People are concerned about their cancer treatment when a Reproductive Endocrinologist and the Oncofertility specialists are brought in, tell us what treatment options are even out there for fertility preservation.
Dr. Patel: For fertility preservation for males it would be sperm banking and cryopreservation of sperm. Sometimes there is not enough sperm, or they are unable to collect, so then microvascular surgical techniques are utilized to extract sperm directly from the testicle. That is for the males. For females, there is the preservation of the eggs. Eggs are frozen. Or, if the couple is already prepared, then they can freeze the embryo or the ovarian tissue of a female can be frozen. There are multiple options available for female patients that depends upon where they are in the stage of their life they can choose.
Host: Does any of this affect how well the cancer treatment works? As the treatment goes on and after treatment, Dr. Patel, how does somebody know if their fertility has been affected?
Dr. Patel: In terms of freezing ovarian tissue or in terms of freezing eggs and embryos, depending upon the cycle and depending upon the hormones that have to be given there may be one to three weeks delay before the treatment gets started. However, that should not affect the overall outcome of the majority of cancer patients. As far as the after-effects of the treatment it depends on what type of cancer, what type of treatment, and in terms of chemotherapy, what dose it is, what side effects, what cycles and the type of drugs that are utilized determine whether these patients will ever have fertility on their own at a future date or not.
The age of the patient also matters. Younger patients that are younger than 35 or even younger than 30 and able to regain their period and even fertility. Patients that are 40 and above are less likely to regain their periods and may undergo menopause. In those patients, the after-effects of premature menopause such as skin dryness, and hair loss, and cognitive function, and bone health, and vaginal dryness, and all of that are there for which they are referred to their Gynecologist for management of after-effects of premature menopause. Did that answer your question?
Host: You absolutely did. Dr. Patel, this is so informative. If somebody has tried one of those options for fertility preservation and they get told that their cancer is in remission or that they don't have it anymore have you seen with your patients that they're scared to then try whatever fertility treatments and preservation that they've used to try to get pregnant for fear that maybe their cancer might come back? What are some of the fears? What have you seen? What have patients told you?
Dr. Patel: The patients, especially breast cancer patients, they have cancers that if they were to now try for pregnancy and family planning, then the hormones that are needed would then increase their risk for recurrence. Generally, it is not true. We advise patients to at least wait for a year and then plan. In other patients, generally, hormone treatment is not considered as a risk factor for planning pregnancy and having a recurrence of cancer. I would say that I encourage my patients once again to maybe visit a fertility specialist and Ob/Gyn person, but I tell them they can absolutely go ahead and plan for a family if they are in remission.
Host: It's great information. Wrap it up, please. Your best advice for people or someone who knows someone has a loved one who might have been diagnosed with cancer but is still young enough to want to have children. What would you tell them about the importance of exploring their treatment options and being a good advocate and finding out what available options are out there for fertility preservation?
Dr. Patel: The best advice is that fertility preservation is absolutely available to all patients who are young adolescents and adults and should be discussed with the primary managing Oncologist. All of these patients should see fertility specialists and Reproductive Endocrinologists because often times they are scared. Often times they are afraid of outcomes of cancer itself and are not addressing this. Later on, it is sometimes not possible. Therefore, it is better to address this upfront before starting the actual management of cancer.
Host: That's great information, Dr. Patel. Thank you so much for joining us today and for sharing your expertise on this topic that may be sensitive to discuss, and not everybody is really willing to ask those questions. Thank you so much for coming on with us today. This is Doc Talk presented by Saint Luke's Cornwall Hospital. For more information, please visit SaintLukesCornwallHospital.org, that's SaintLukesCornwallHospital.org. I'm Melanie Cole. Thanks for tuning in.