Reproductive issues

For young women with cancer, discuss fertility early, South Florida experts say

 

Cancer treatments can make it difficult, and sometimes impossible, for a woman to conceive. The course of treatment, the cancer type and the patient’s age determine how high that risk is.

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Like many young female cancer survivors, Kelly Lara could never silence her fears that she might not be able to have a child.

Lara, 22, was only 3 when she was first treated for leukemia. Through chemotherapy treatments, she went into remission when she 6, but 10 years later the cancer returned in the form of an ovarian cyst. Doctors at Miami Children’s Hospital informed Lara there was a risk of infertility with treatment.

“I knew I always wanted to be a mom,” said Lara, who lives in Kendall. “When they said there is going to be some difficulties getting pregnant from the treatment, it shocked me. I was devastated.”

Cancer treatments can make it difficult, and sometimes impossible, for a woman to conceive. The course of treatment, the cancer type and the patient’s age determine how high that risk is.

Treating the reproductive organs leads to the greatest risk of infertility. Dr. Ziad Khatib, director of neuro-oncology at Miami Children's Hospital, knew that if they performed radiation on Lara’s entire abdomen, it could very well render her unable to have children.

“We kept going back and forth with treatment options because we wanted to save my life and save my future chances of giving birth,” Lara said.

Khatib and Lara decided the best option would be targeted chemotherapy and radiation, focusing only on the ovary containing the mass and protecting the other ovary.

Lara responded well to the treatment and went into remission in December 2010. But she was still not out of the dark when it came to conception.

“I always had that fear of the unknown, especially since they tell you that infertility could be a reality,” Lara said. “Would I have a child?”

Last year, her concerns vanished with the news that she was pregnant. Her daughter, Leah, was born in March.

“When I first found out, I freaked out because I was so excited,” said Lara. “It was a blessing.”

Lara says she was fortunate to have doctors who considered not only how to fight the cancer, but her life after the battle.

“It is important that they put everything on the table,” Lara said. “Doctors should do all they can to help better my chances or anyone thinking of having children in the future while treating the cancer. It was very important that they were listening to me.”

The American Society of Clinical Oncology updated guidelines in 2013 that advised physicians to discuss the risk of fertility with cancer patients as early as possible and refer them to a reproductive endocrinologist promptly.

Dr. Marcelo Barrionuevo, a reproductive endocrinology and fertility specialist at Memorial Regional Hospital in Hollywood, says it is especially crucial to help the patient make a decision earlier rather than later to avoid delaying treatment.

Some women opt to freeze their eggs before treatment to increase the likelihood of pregnancy. That option, however, can postpone treatment by a few weeks since the procedure is aligned with a woman’s menstrual cycle.

“We work very closely with the cancer specialist in going the extra mile to communicate with the patient and expedite the process,’’ said Barrionuevo. “We all as a team try to make it very simple for them so it won’t delay treatments or add more stress.”

Alina Bogdan, 29, was initially not afforded these options. Bogdan, a native of the Cayman Islands, was diagnosed with ovarian cancer in August 2010. Doctors there told her she would have to undergo a hysterectomy to remove her ovaries and cervix.

Bogdan was in a relationship and she and her boyfriend were were discussing marriage and children.

“I did not want to give up on my dreams,” Bogdan said. “I was talking to doctors and they told me, ‘You’re not realistic.’ 

Bogdan sought a second opinion in South Florida, where she became a patient of Dr. Nicholas Lambrou, medical director of minimally invasive gynecological surgery at South Miami Hospital. Instead of performing a hysterectomy, Lambrou was able to pinpoint the abnormality using robotic surgery and removed the cyst.

“The procedure kept her organs that were not affected intact and gave her a much quicker recovery,” Lambrou said. “She went home the next day and she is now in remission.”

Not only is Bogdan cancer-free, she is expecting. Her then-boyfriend became her husband and she is scheduled to deliver her baby at South Miami Hospital at the end of May.

“It is a miracle,” said Bogdan. “I was struggling for my life and now I am going to deliver a baby.”

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