Talking about fertility
It's best to talk about ways to preserve or protect your fertility before cancer treatment begins.
Fertility is something your treatment team should discuss with you, but you can also bring up the topic yourself. See suggested questions to ask.
Some people feel too overwhelmed by the amount of cancer information they are given at diagnosis to think about fertility. Or you may need to make fertility decisions before you've given much thought to whether you want to have a child in the future.
Even if you think, "But I don't want kids anyway" or "My family is complete", a fertility specialist or counsellor will probably encourage you to consider as many fertility options as possible to keep your choices open for the future. These decisions are personal, and no decision is right or wrong. The section below about making decisions may be helpful.
If you aren't offered the opportunity to see a fertility specialist before treatment, ask your GP or cancer specialist for a referral.
"The first time I met my surgeon she said, `You should go and see a fertility specialist.' It all happened very quickly. The only way to describe the process is that it was overwhelming. However, it's better not to delay it." - Mackenzie
What to consider when making decisions
After a cancer diagnosis, you will probably need to make several decisions about your fertility. This can be a confusing and complex process, particularly if you have several options to consider. You may feel that everything is happening too fast.
Understand the available options
Generally, people make decisions they are comfortable with - and have fewer regrets later - if they gather information and think about the possible consequences. Consider the pros and cons of each option to help you make a well-informed decision.
Expect to experience doubts
It's common to feel unsure when making tough decisions. Keeping a journal or blog about your experience may help you come to a decision and reflect on your feelings.
Ask your health professionals to explain your treatment options, and the benefits and side effects of each.
Talk it over
Discuss the options with those close to you, like your partner or a close friend. As most decisions will affect others in your life, it's also important to consider their opinions.
Use a decision aid
A decision aid can help you make choices about different treatment options by focusing on what matters most to you. Breast Cancer Network Australia has developed a resource called Fertility-related choices to help younger women with breast cancer make fertility-related decisions. See Breast Cancer Network Australia's booklets and factsheets.
Which health professionals will I see?
There are several people you may see to discuss fertility, including:
- fertility specialist - doctor who has experience managing fertility issues
- reproductive endocrinologist - doctor who has completed additional training in the diagnosis and treatment of infertility
- paediatric gynaecologist, endocrinologist, surgeons - specialise in hormones and fertility care of children with cancer
- fertility counsellor - counsellor who provides advice for people who are experiencing fertility issues
- genetic counsellor - counsellor who provides advice for people with a strong family history of cancer or with a genetic condition linked to cancer.
When making an appointment, let the clinic or specialist know that you are having treatment for cancer so that they give you an appointment as soon as possible. During the appointment, the specialist will outline the options available to you. Your cancer specialist will make suggestions, and together you can decide what works with your cancer treatment plan.
If you have a partner, try to attend appointments together and include them in the decision-making process. You may also wish to bring a family member or friend for support.
Some people find talking to a fertility specialist stressful. It may help to plan some questions in advance and to take notes during the discussion. The information about dealing with emotional issues may also be helpful.
The main costs of fertility treatment
Fertility treatments can be expensive, and this may be a factor in your decision-making. Costs vary across Australia and between clinics. Ask your fertility specialist about Medicare rebates and talk to your health insurance provider if you have private health cover.
Initial fertility specialist consultation and pre-treatment tests
You need a referral from your GP, cancer specialist or a specialist obstetrician/gynaecologist to be eligible for Medicare rebates. A referral should list both you and your partner to enable you to claim the maximum benefit. Ask the fertility specialist if they have special fees for people diagnosed with cancer, as sometimes this is the case.
The procedure (e.g. IVF cycle/day surgery)
The fees will depend on the procedure and whether you are a public or private patient.
As a private patient, there may be Medicare rebates for some procedures, including blood tests, fertility specialist consultations and medicines. Although there is no Medicare rebate for private day surgery procedures, some rebates exist for anaesthetist services.
If procedures occur in a public hospital fertility unit, there will be no fees for procedures, day surgery or anaesthetist services. You may, however, experience long delays waiting for treatment.
Egg, sperm and embryo storage/cryopreservation
These may be called advanced science costs. Storage costs vary for reproductive tissue. Ask your fertility specialist about up-front payments, instalment payments and annual fees.
Expert content reviewers:
Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children's Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children's Cancer Centre, Monash Children's Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women's and Children's Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women's Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women's Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.