DEAR MAYO CLINIC: I've heard that colorectal cancer is becoming more common in younger adults. If either my husband or I were diagnosed with that or some other type of cancer, would it affect our plans to build a family?

ANSWER: No one at any age wants to receive a cancer diagnosis. But it can be particularly difficult for younger adults who are told they have cancer in the prime of life. What many young adult patients don't realize is that treatments that can save lives, such as chemotherapy, radiation and surgery, also can potentially affect their ability to have biological children. 

For some women, their cancer treatment may include hormone deprivation therapy, which can stretch five or more years. The completion of treatment may correspond with their natural menopause or put them into an early menopause, impairing their ability to conceive. 

Although fertility risk centers around the treatments and intensity of treatments, certain cancers often require therapies known to carry a higher risk to reproductive cells, including blood, gynecological and soft tissue/bone cancers, and breast and testicular cancer.

Fertility preservation

Along with explaining the diagnosis, the oncologist will explain the type of treatment the patient will receive and the potential risks to fertility. A conversation about fertility preservation may be conducted with the oncologist, nurse, social worker or reproductive specialist. This designated member of the patient's healthcare team can provide information to help them make this personal decision. Keeping religious, cultural and social values in mind, they may ask questions to better understand the patient's goals and support their decisions about family building. 

Decisions about fertility can feel especially overwhelming when patients are still grappling with the shock of hearing the word "cancer." Many people find it helpful to include a spouse, partner, family member or close friend in these conversations to provide support and help process the information. 

Fertility decisions often have to be made quickly because cancer treatment may need to begin soon after diagnosis. In some cases, patients may have only a few days to consider fertility preservation options. Some people don't desire biological children in the future, and so the decision is straightforward. For others, preserving the option for biological children is important, and they are willing to postpone cancer treatment. 

Family building options

Sometimes, with aggressive cancers, time doesn't allow for fertility preservation, and family-building conversation takes a different direction toward helping the patient cope with feelings of grief and loss or toward considering their options for building a nonbiological family. These options can include adoption, use of donor eggs, sperm or embryos, or use of a gestational carrier (surrogacy).

If it's medically safe to briefly delay cancer treatment, and a patient wishes to preserve the option of having biological children, then eggs, embryos or sperm may be cryopreserved (frozen) for future use.

For men, typically the sperm collection process can be done quickly, either at a fertility clinic or with a mail-in kit, which allows for collection in the privacy of their own home.

Women face greater barriers. The process of stimulating ovaries to produce multiple eggs includes two to three weeks of hormones, frequent lab and transvaginal ultrasound monitoring, and a minor surgical procedure called an "egg retrieval."  With this longer time frame, women need to partner with their care teams to weigh the benefits of egg collection against the risk of delaying treatment. 

Fertility preservation can involve considerable financial costs, and insurance coverage varies. Patients are encouraged to check their benefits early, and many nonprofit organizations offer grants or financial assistance to help offset expenses.

It's important to remember that cancer treatment doesn't always lead to infertility. Some patients maintain fertility and can have children after treatment, either naturally or with medical support.

Patients interested in learning more about fertility preservation should consult with a reproductive specialist who can provide detailed information about the fertility preservation option that is right for them.

A cancer diagnosis can stop young adults in their tracks. It's usually something they never thought they'd have to deal with, just as they're starting their careers, establishing relationships, becoming more financially stable and envisioning their future, including building a family. Throughout this journey, their cancer care team is there to support them and help navigate decisions they never expected to face.

Elysse Casson, Oncology Certified Nurse, Adolescent and Young Adult Cancer Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic in Arizona

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