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Fertility Preservation: Preserving Possibilities

contributed by Jessica Webster Sendra

Certain cancer treatments can affect fertility, but Rogel offers ways to preserve your ability to have children before starting treatment for your disease. Molly Moravek, M.D., outlines the options.

Molly Morevek, MD
Molly Moravek, M.D. Photo credit: Erica Reist Bass

Ask Molly Moravek, M.D., why she pursued a career in fertility preservation for patients with cancer, and she'll tell you it's because her heart breaks whenever she sees a patient who’s had their ability to have children taken away from them.

"It's the patient who was never told that their cancer treatment was going to affect their fertility or who is here once they’ve already started treatment and I can't offer much," says Moravek, the director of U-M Health’s Fertility Preservation Program. "Or maybe a provider mentioned it but didn't really emphasize it. And then I'm the one who has to tell the patient that their reproductive organs are no longer working properly, and they will probably never be able to use them to have a baby."

Working Toward Inclusivity

By Eric Olsen

When Michigan Medicine researcher Emily Walling, M.D., conducted a fertility preservation study with adolescent and young adult (AYA) cancer patients, some reported that Rogel's fertility preservation program was often at odds with their identities, intimate relationships and family planning goals.

“They were vocal,” says Walling, co-medical director of U-M Health’s AYA Oncology program. “They made sure we understood that the program was not meeting their needs as queer-identifying people.”

When the team searched for other studies in the area of queer fertility, they discovered that virtually no research had been conducted.

In response, Walling and co-investigator Nina Jackson Levin launched the Sexual and Gender Minority Oncofertility study to recruit patients and survivors who do not identify as cisgender or heterosexual.

“We ask about how we approach the conversation around fertility, and if there are things we could be doing better to be more inclusive,” Walling says. “Our goal is to improve our approach to be more inclusive, including the language we use. We want everyone to feel heard and seen, less marginalized, and more likely to consider fertility preservation services.”

Chemotherapy, radiation and some immunotherapies can interfere with a patient's reproductive system and affect their ability to have children. The option to preserve eggs or sperm prior to treatment has long been available, but it’s often not communicated to patients early enough in the process.

Moravek wants to change that.

She’s built a program in partnership with U-M Health’s Center for Reproductive Medicine and the Rogel Cancer Center that works with patients and their oncologists to preserve patients' opportunity to have children.

Moravek spoke to Thrive about cancer fertility preservation and what makes U-M Health's offerings unique.

Q. Who is cancer fertility preservation for?

People of reproductive age who are getting ready to undergo chemotherapy, radiation or removal of their ovaries or testes. We can freeze their eggs or sperm, or if they have a partner, we can freeze embryos. We also have medical options to offer them, although they are not as effective.

Q. What does cancer fertility preservation involve?

The quickest and easiest option for people with ovaries is an injection that shuts the ovaries down — the thought being that chemotherapy attacks rapidly dividing cells, and if we can make the ovary quiet, then maybe it won't be as susceptible to chemotherapy. This option is considered experimental.

If we have more time, I can freeze eggs or embryos in as little as two weeks. We can get them right back to the oncologist, and patients can start chemotherapy the next day.

Preserving sperm is easier. The problem is: A lot of people with testes who have cancer will have decreased sperm count or difficulty producing a sample. Our reproductive urologists can help with that. They can also counsel those patients on how many samples they should freeze given their number of sperm.

Q. How is U-M Health's program different from other fertility programs?

We're not just a fertility clinic that freezes eggs, embryos and sperm. We are a comprehensive program with doctors trained in different chemotherapies and their risk profiles, nurses comfortable with the accelerated schedule of a patient with cancer, fertility-trained mental health professionals and a fertility preservation program manager.

We're focused on making this as patient-friendly as possible, and a big part of that is our program manager. She communicates with the patient's oncologist and helps incorporate fertility preservation into their cancer treatment plan. She also helps patients schedule appointments and figure out their prescriptions and insurance coverage. We don't want fertility preservation to be one more hard thing a patient has to do.

Q. Why is it important to offer fertility preservation to patients facing cancer treatment?

Lots of patients are shocked by the loss of fertility at the end of their treatment; multiple studies show this is one of the most pervasive regrets for patients. They either feel guilty that they didn't do it, or they feel angry that nobody talked to them about it.

Studies show that even fertility counseling matters. For those patients who chose not to preserve their fertility, the chance to make an informed, educated decision still mattered when asked about their decision after their cancer treatment.

I see fertility as a health issue, not a luxury. I think everyone should have the right to have a baby. If we know we’re doing something with a high likelihood of taking that away from them and we can intervene, why wouldn't we?

When you're going through cancer treatment, having hope is important. Your oncologist sent you to me because we're talking about life after cancer treatment. That's a good thing. If they didn't think we could be talking about your life after cancer, they wouldn't be sending you. Let's talk about the good things to come.

Learn more about fertility preservation at Michigan Medicine

Visit the Fertility Preservation webpage

Check out our Fertility Preservation resources -- including information for LGBTQIA+ people.

Thrive Issue: 
Spring, 2023