Fertility preservation in the face of cancer

February marks World Cancer Day, and to mark the month, we hosted a "fertile conversation" to address the disease and the implications of its treatments on fertility. At Fertilidad Integral, we believe that information is key to making free and informed decisions, and in situations where the possibility of achieving a pregnancy may be affected—as is the case with cancer—it is essential. This conversation, which brought together Yanín Chavarri, a breast cancer oncologist; José Gutierrez, an obstetrician and reproductive biologist; María Altschuler, CEO of Fertilidad Integral; and Zadeth Melo, a cancer survivor, is proof that medical horizons can only expand when experts listen to what their patients want and need; when care is not only individualized but also empathetic and human.

From the beginning of the conversation, Yanín noted that breast cancer is the most common type in Mexico. In recent years, the number of patients under 40 suffering from it has increased considerably; women who, in many cases, have not yet had children. Women who, without the necessary information, could lose the opportunity to have them as a result of chemotherapy. As Yanín asserts, fertility plans are not usually the focus of attention after a cancer diagnosis. Naturally, in a situation like this, efforts tend to be focused on finding ways and alternatives to preserve life. From the moment of diagnosis, everything is about defining which treatment to follow and when is the right time to start.

Zadeth discovered she had breast cancer at age 37. Although she didn't know when, she was very clear that she wanted to have children. However, faced with news like this, her fertility plans fell to the bottom of her priority list. In her words, "the focus was on the cancer, and everything else was left out". To a large extent, this reaction was due to the fact that she was completely unaware that treatment for this disease could have negative effects on her fertility, and she did not know that alternatives existed to preserve it.

Fortunately, her gynecologist was one step ahead. So, after providing her with information about the possible effects of chemotherapy on ovulation and the ovaries, he suggested freezing as an option to increase her chances of conceiving in the future. Even so, freezing was not an easy decision to make. On one hand, there was the fear of postponing the start of her cancer treatment, and on the other, there was her family's insistence that "she should look after her life first and everything else later". With a million emotions involved and a six-week deadline to decide whether or not to freeze, she finally decided to go ahead with it. For Zadeth, psychological support was a key piece in gaining the strength to take the next step.

José and Yanín immediately understood the fear Zadeth had to face, as acting quickly is indeed of vital importance in any cancer treatment. So, a decision that can normally be analyzed calmly became a race against the clock for her. But, as the specialists acknowledged, perhaps that fear could have been reduced if Zadeth had known from the beginning that there are many paths, that today there are options to prevent the hormonal treatments for freezing from stimulating the cancer, that there are women who can get pregnant after the disease without treatment, and that freezing secures future possibilities.

Although Zadeth is now cancer-free, she will continue treatment for five more years. Sometimes she still wonders if her desire to be a mother will still be there by then, but she feels proud to have made that decision, because she knows that her possibility is still there, that she owed that to her future self. That is the key: to be able to act with freedom, it is essential to have information that allows you to decide. And that is why, when a woman visits Yanín's office, she considers it fundamental to ask about her fertility plans and desires. Because, before being people with cancer, her patients are human beings who should be able to decide about their bodies and their future. Also, because as Zadeth says, "if the doctor hadn't suggested it, her options would probably have been lost."

This conversation and Zadeth's courage remind us that we must think about interdisciplinary medicine that makes visible and responds to the needs of patients, because that can make all the difference. It also demands that we continue to open up conversations because the more—and the sooner—we talk about it, the more likely it is that patients will know what options they have from the start. Zadeth's voice helps us recognize the taboos that still painfully permeate processes that are already difficult enough. It is a reminder that, as a society, we still have much to learn; that the world is changing, and so is medicine. Her optimism, along with statistics showing that more and more people are surviving this disease, leaves us with one final message: there is life after cancer. That is why we now have the mission to think about what we can do so that those who are going through this path have access to the options they need to decide and enjoy their lives to the fullest.