Young Breast Cancer Patients Grapple With Fertility

PHOTO: Cristal Miller was diagnosed with breast cancer at 27 years old.PlayMount Sinai Medical Center
WATCH Breast Cancer, by the Numbers

It was just a few days before Christmas last year when Crystal Miller received the phone call that changed her life: Even though she was only 27 years old and had no risk factors, she had breast cancer.

Miller, an licensed nurse who works in oncology data research at Mount Sinai Hospital in New York City, said she started crying even before she hung up the phone.

"What did I do with my life?" she remembered asking herself. "I should have been having more fun. I should have had a family by now."

Still, she was stunned when, a few weeks later, her oncologist suggested that she speak to a fertility specialist. Amid fighting for her life, saving her future hypothetical children never crossed her mind.

However, female chemotherapy patients often face immediate decisions concerning their future ability to get pregnant.

Miller, a patient at the Dubin Breast Center at The Mount Sinai Hospital, learned that chemotherapy would age her ovaries by 10 years and that, even after treatment, pregnancy would be a challenge because she’d be on a drug called Tamoxifen, which she’d have to stop taking if she wanted to get pregnant. She could freeze her eggs now and implant them later to have a better chance at a healthy baby, but it wasn’t a sure thing, she said.

“I walked out of his office and I just started crying,” she said. “Hearing ovaries can age by 10 years. I’m 27 now. That’s 37.”

Nevertheless, Miller feared that undergoing fertility treatments could delay her chemotherapy. And because she didn’t know yet what stage her cancer was, she decided she couldn’t wait.

She opted not to go through the process of freezing her eggs, saying she just wanted the cancer out of her body, even if it meant that children might not be in her future.

“I just wanted it out of me,” she said. “That was my emotional reaction. ... I didn’t want to have to do this again.”

She said she didn’t know whether she would have made the same decision if she was in a relationship. And now, even though she’s not dating anyone, she said she worries about what a new boyfriend might think of the fact that she might not be able to have children.

“I thought I was making a decision for my future husband,” she said.

Regardless of those fears, she said it was the best decision for her at the time and she doesn’t regret it.

Dr. Alan Copperman, who directs the division of reproductive endocrinology and infertility at Mount Sinai Hospital in Manhattan, said while altering the patient’s cancer prognosis by delaying treatment for fertility-saving measures is at the forefront of his mind, it’s often not a problem. Chemo is often not delayed more than a few days, and he’s had women come back after treatment and have healthy babies.

“It is unbelievably rewarding to hear the heartbeat, to share that joyous event with the patient and send them off to their obstetrician,” Copperman said.

Though specialists like Copperman have been able to freeze eggs for decades, he said the procedure has become more popular, in general, over the last seven or eight years.

The biggest obstacle is making sure cancer patients know about their fertility options, said Dr. James Goldfarb, who directs the fertility program at UH Case Medical Center in Cleveland. Oncologists are sending patients to fertility specialists more and more, but some young patients don’t learn about their options until it is too late.

“We still see patients who come to us after having chemo and are now in menopause, and [we] wonder if we can do anything for them at that point,” he said.

Still, freezing one's eggs is not for everyone, Copperman said.

“They should, at least, not look back and say ‘Wow, I wish I knew about it,’” he said.