HOUSTON – No matter the kind of cancer, the kind of treatment someone gets upon diagnosis can destroy fertility.
That's why doctors at Texas Children's Hospital have a difficult decision they need parents to make before they begin treatment.
Parents need to decide whether to pay to freeze their little girl's eggs or little boy's sperm in order to give them a better chance at having children later in life, but that decision is extremely complicated.
“We try to be as sensitive as possible yet also reassuring and giving them confidence that we're going to get them through this,” said Dr. Paul Austin, chief of pediatric urology at Texas Children's Hospital.
Some states require insurance to cover the cost of preserving fertility in cancer patients, but Texas only offers infertility treatment, meaning a cancer patient must later prove being infertile.
Dr. Monica Gramatges, pediatric oncologist and co-director of the Long Term Survivor Program at Texas Children’s Cancer and Hematology Centers, said it's never a guarantee that a child will lose their fertility during treatment but it is a possible risk of every kind of cancer treatment.
“In very rare cases is it a 100% guarantee you'll never be able to conceive,” she added. “Just because you went through this experience doesn't mean that it's impossible for you to have children.”
OPTIONS FOR BOYS
In order to store sperm, boys should be past puberty.
They have better outcomes against some treatments.
“The toxic effects of chemotherapy are generally more reversible than the radiation," Austin said. "So the radiation is the one that really is concerning about the irreversible impact on the testes for sperm production so that goes back to then either trying to scale back the dosing or shielding the testicles or genitalia or giving the radiation in a more dose fractionated manner."
OPTIONS FOR GIRLS
The decision can be even more complicated and costly for girls.
For girls with mature eggs (post-puberty), the first procedure to retrieve the egg is about $10,000, according to Gramatges, and that’s just one cycle.
Younger girls can have an ovary removed and preserved for transplant later. However, that is an experimental procedure that Gramatges said has only resulted in about a hundred live births.
Therefore, she said, most families see this option as too much of a gamble.
“Given the low likelihood of this producing a live birth, it's, few families are willing to take on that kind of risk under those circumstances,” she said.