Options for Having a Family After Treatment
Many patients will be able to conceive naturally after cancer treatment. Patients are generally counseled to wait at least 2 years after treatment is completed before attempting conception. Check with your doctor to find out how long after treatment you should wait. If you are not able to conceive naturally, there are a number of other ways to build a family.
Human reproduction requires three elements: mature sperm, mature eggs and a person with a uterus to carry the pregnancy and give birth. Sperm may be from the patient, a partner or a donor. Eggs may be from the patient, a partner or a donor. The patient, a partner or a surrogate may carry the pregnancy. There are many different options and combinations that can lead to a healthy pregnancy and child.
Medically Assisted Conception
- Use of frozen sperm. Depending on the number of vials stored and the number and quality of the sperm specimens, there are two ways to use frozen sperm— artificial insemination and in vitro fertilization (IVF). Artificial insemination involves the injection of semen into part of the reproductive tract of a partner with a uterus (or a surrogate) by a method other than sexual intercourse. Or, the sperm can be used to fertilize mature eggs, collected during an IVF cycle from a partner (or donor), in a laboratory to create embryos. The embryos are then transferred into the uterus of a partner or a surrogate who will carry the pregnancy.
- Testicular sperm extraction (TESE). If no sperm are present in the semen, this surgical procedure, performed under anesthesia, can be considered. The doctor removes pieces of tissue from the testes. The tissue is then examined for mature sperm. If sperm are found, the sperm can be used to fertilize mature eggs collected during an IVF cycle from a partner (or donor) in a laboratory to create embryos. The embryos are then transferred into the uterus of a partner or a surrogate who will carry the pregnancy.
- Use of frozen eggs or embryos. If eggs were frozen, they will first be fertilized with a partner or donor’s sperm in the laboratory to create embryos. The embryos are then transferred to the uterus of the person who will carry the pregnancy so pregnancy can occur.
- In vitro fertilization (IVF). If a patient has a low egg count (a low ovarian reserve), they may want to consider undergoing an IVF cycle to remove mature eggs to be fertilized with a partner or donor’s sperm in a laboratory. The embryos are then transferred to the uterus of the person who will carry the pregnancy so pregnancy can occur.
- In vitro maturation (IVM). If the hormone fertility treatment typically used in IVF is contraindicated for the patient, immature eggs may be collected from the ovaries after only brief fertility treatment or without fertility treatment. (Immature eggs can also be collected from surgically removed ovarian tissue.) Since these eggs will not have fully matured in the ovaries, the eggs must then undergo IVM, which means that the eggs will mature in a laboratory. Researchers are still learning about IVM.
- Donor sperm. Sperm donated by another person is used to produce a pregnancy through artificial insemination or IVF.
- Donor eggs. Eggs donated by another person (who undergoes an IVF cycle) that are fertilized and transferred to the uterus of the person who will carry the pregnancy.
- Donor embryos. Embryos are generally donated by couples who have undergone IVF for infertility. If they do not plan to use the embryos, they may choose to donate their remaining embryos rather than discard them.
- Surrogacy. If you and your partner are both unable to carry a pregnancy and/or deliver a baby safely, you may be able to arrange for a person with a uterus (a gestational carrier) to carry the fetus for you. Embryos created with your, your partner’s or a donor egg and sperm are transferred to the surrogate’s uterus. In most cases, the egg will not come from the surrogate. The egg will come from a parent or a different donor. The surrogate will not be genetically related to the resulting child. This is called “gestational surrogacy.” Surrogacy where the egg is from the surrogate is called “traditional surrogacy,” and it is not legally supported in most states. Laws surrounding surrogacy, the surrogacy process and the enforcement or legality of surrogacy contracts differ greatly from state to state. If you are considering this option, it is extremely important to speak to a reproductive lawyer who is knowledgeable about surrogacy law.
Adoption is another way to build a family after cancer treatment. In general, people who have been treated for cancer but are free of disease are eligible to adopt infants or older children. Ask any agency you plan to use if they have worked with other cancer survivors, and if not, ask if they are open to working with you. You may need to talk to multiple agencies to find the one that is the best fit for you. Adoptions laws can also differ state to state.
At this time, adopting from within the United States is generally easier than adopting internationally. However, agencies and attorneys can provide guidance on which countries may be willing to work with you because policies vary from country to country.
As you discuss and think about adoption, you will need to consider the cost. Expenses incurred in the adoption process can total in the thousands of dollars. There are organizations that provide some financial assistance for this, and some tax benefits can help with qualified adoption expenses.
Foster-to-adopt. Another option is to adopt a child that you have been fostering. This process is often funded by the state and has fewer fees. However, it’s important to remember that not every foster situation leads to adoption. In many foster situations, the goal is to reunite the child with their birth family. Foster parents will need to support this goal. Some states offer specific foster-to-adopt programs with the expectation that the child will be adopted by the foster parents if the child either is or becomes eligible for adoption. Ask about all options if you are interested in fostering and/or adoption.
- Download or order The Leukemia & Lymphoma Society’s free fact sheet, Fertility Facts.