Roxana Chaviano is not sure if she wants kids. Launching a pharmaceutical career, finding a partner come first.
But when she was diagnosed with breast cancer in February, the 31-year-old underwent fertility treatment and froze her eggs before beginning chemotherapy. This way, she could decide whether to have a family, rather than the cancer deciding for her.
"You get a cancer diagnosis and it can be really hard to picture a future and to want to invest into something that is very unknown to you at the time," she said. "But I feel like it's better to have the option than no option at all."
Chemotherapy and radiation can damage a woman's ovaries and prevent the release of eggs or estrogen necessary to become pregnant. While fertility preservation treatments can boost a woman's chances of having children in the future, they vary in procedure and success.
For most breast cancer patients, infertility is a non-issue - most women diagnosed with breast cancer are 45 or older and past child-bearing age. Data from the Centers for Disease Control and Prevention show that while breast cancer is the most common cancer among women in the country - 1 in 8 women will get breast cancer in her lifetime - only 9 percent of cases are found in patients younger than 45.
Still, that 9 percent accounts for tens of thousands of young women each year, including Chaviano.
That number could be growing. Dr. Pasquale Patrizio, chief of the Division of Reproductive Endocrinology and Infertility at the University of Miami's Miller School of Medicine, said he's seen an uptick in diagnoses of breast cancer among younger women in the last couple of years.
He still doesn't know why and hasn't found any particular commonalities among the patients' demographics, but it could mean more breast cancer patients seek fertility preservation in the future.
Freezing eggs, embryos
Chaviano consulted with Patrizio before pursuing her fertility preservation treatment. He walked her through four options of fertility preservation: freezing eggs, freezing embryos, freezing ovarian tissue, and injecting hormones during chemotherapy cycles.
Apart from the hormone treatment, all fertility preservation methods must begin before chemotherapy. This time sensitivity can impact which method works for which patients; some may be able to wait a couple weeks after receiving a diagnosis to begin chemotherapy, while others with more aggressive cancers might not be able to forestall treatment.
Freezing a woman's eggs and freezing an embryo are the most common options for fertility preservation. Each takes about two weeks, on average, and they have the highest success rates.
For patients 35 and younger, there is a 60 percent success rate with 14 to 15 harvested eggs. The success rate dwindles to 50 percent with 25 harvested eggs for women older than 35.
"If you're younger, the quality of the egg is better," Patrizio said. "For breast cancer, women are considered young when they are diagnosed at 32 years old or younger."
With embryo freezing, the success depends on the number of viable embryos.
"For every 10 eggs that we collect, we are generally able to have about three to four good embryos," Patrizio said. "Out of those, we are looking at a 40-50 percent chance that the patient will be able to have a child."
Freezing ovarian tissue
Freezing ovarian tissue is another option, one more accessible for cancer patients who need to start treatment quickly. This involves surgery to remove a small piece of the ovary, a process that is complete within two to three days.
"If the patient becomes menopausal after receiving chemotherapy, the ovarian tissue can be reintroduced to the body and could produce viable eggs," Patrizio said. "Once we transfer the ovarian tissue back, the chance of success is between 30-40 percent. But again, it is dependent on the age at which we collect the tissue."
Hormone injections are the fourth option, taken once a month during chemotherapy cycles to block menstruation, creating an artificial menopause. The injections, usually a shot in your arm, thigh, hip or under the fatty part of your belly, are meant to rest the ovaries during chemotherapy to decrease the chances of damage. Patrizio said they have a 50 percent success rate.
Regardless of method, Patrizio said fertility preservation should be considered by all young patients with cancer because cancer is becoming more treatable year after year. Patients should discuss their options with their doctor.
Affording fertility preservation costs
For Chaviano, freezing her eggs and watching them develop was the highlight of her first few months with a breast cancer diagnosis.
"You go into the office every two weeks and you start seeing how the follicles start growing," she said. "It's actually really cool. I was very excited."
The biggest drawback was the cost.
Florida has no mandate for insurance to provide coverage of fertility treatments, often making the procedure a hefty out-of pocket expense. The procedure of freezing eggs can cost more than $10,000. Many private fertility clinics also offer annual storage fees of hundreds of dollars to preserve the eggs.
Foundations and pharmaceutical companies that offer financial assistance in accessing these treatments exist, but can be hard to find.
Sylvester Comprehensive Cancer Center at the University of Miami has an Adolescent and Young Adult (AYA) Program to help connect patients with financial resources. Chaviano received guidance from the AYA Program in accessing her own fertility preservation treatment.
"AYA stands for adolescents and young adults, and the official definition that the National Cancer Institute adopted for this age group was people from 15 years to 39 years of age, diagnosed with cancer," said Julio Barredo, director of children's cancer programs at Sylvester.
"One of the big, long-term toxicities of cancer therapy is you lose your fertility," Barredo said. "So, it takes a program and a team that has experts in fertility preservation to help people get through their cancer therapy and, in some form, be able to preserve fertility or preserve the possibility of having children later on if they wanted to."
Susan Komen Walk
Susan G. Komen More Than Pink Walk: The 27th annual breast cancer awareness walk begins at 9 a.m. Saturday, Oct. 8, at Amelia Earhart Park, 401 E 65th St., Hialeah. For information, call 1-877-GO KOMEN ext, 4, email email@example.com, or visit komenmiaftl.org.