Anna is a 34 year old that was recently diag­nosed with col­orec­tal can­cer. Many pub­lic fig­ures devote their time and effort to pro­mote aware­ness of col­orec­tal can­cer. Colon can­cer in young women and men and its effect on future fer­til­ity com­monly pass unnoticed.

Anna’s oncol­o­gist told her that the treat­ment of her can­cer should include chemother­apy and pelvic radi­a­tion fol­lowed by surgery. She was inter­ested in get­ting preg­nant after her can­cer treat­ment. Her oncol­o­gist did not dis­cuss fer­til­ity issues with her but luck­ily her sur­geon did. She was referred for con­sul­ta­tion with a repro­duc­tive endocrinologist.

The effects of col­orec­tal can­cer treat­ment were explained:

1. Chemother­apy for colon can­cer is rel­a­tively benign and likely will not result in loss of fertility
2. Pelvic radi­a­tion at doses used for colon can­cer will very likely result in com­plete loss of ovar­ian function
3. Pelvic radi­a­tion will also dam­age the uterus mak­ing future preg­nancy in her own uterus unsafe.

She needed a spe­cial plan to pre­serve her fer­til­ity tai­lored specif­i­cally to her, her fam­ily and her tumor. Options dis­cussed with her included

1. Ovar­ian stim­u­la­tion, egg retrieval, fer­til­iza­tion with hus­band sperm and freez­ing the result­ing embryos. Embryos could be later trans­ferred to a ges­ta­tional car­rier,
2. Mov­ing one ovary away from the pelvis to avoid radi­a­tion dam­age (ovar­ian trans­po­si­tion) and / or
3. Remov­ing one ovary and freez­ing it for later transplantation.

The last two options could take place simul­ta­ne­ously through min­i­mally access surgery.

After exten­sive dis­cus­sions, Anna and her fam­ily opted for option one only (freeze embryos). Her oncol­o­gist and sur­geon approvals were obtained. Stim­u­la­tion of the ovaries, retrieval, fer­til­iza­tion and embryo freez­ing was accom­plished in two weeks with­out delay­ing her can­cer treatment.

Fol­low­ing pelvic radi­a­tion, her men­strual cycle ceased and she expe­ri­enced hot flashes.

Fast For­ward…

One year later, Anna came back for the embryos. She wanted to carry in her own uterus but was dis­cour­aged from doing that. She finally agreed to use a ges­ta­tional car­rier. After a short search, the fam­ily met some­one they trust to carry their baby.

The car­rier was tested and found to be med­ically suit­able. After prepar­ing her uterus with hor­mones, Anna’s embryo was thawed and trans­ferred. To Anna and everyone’s delight she got preg­nant. Finally the car­rier deliv­ered a beau­ti­ful girl! What is heart-warming is the fact that Anna has more frozen embryos. She can do it all over again if she chose to.

Men diag­nosed with col­orec­tal can­cer, espe­cially if they require pelvic radi­a­tion, can also pre­serve future fer­til­ity through sperm freez­ing. This is cer­tainly an avail­able and sim­ple tech­nol­ogy, lim­ited only by the avail­abil­ity of appro­pri­ate and timely coun­sel­ing by oncol­o­gists and fer­til­ity preser­va­tion spe­cial­ists. The sperm sam­ples are then used either for intrauter­ine insem­i­na­tion or IVF with ICSI (intra­cy­to­plas­mic sperm injection).

Call to action; even in extreme sit­u­a­tions, don’t lose the courage to fol­low your instinct to hav­ing a baby. Nobody said its sim­ple but it is def­i­nitely pos­si­ble!
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