Fertility and cancer: Should you delay your treatment?

Amy Miller and Justin Ward in 2012 Amy Miller and Justin Ward received fertility counselling immediately after Dr Miller was diagnosed with cancer

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When Amy Miller was diagnosed with bowel cancer in March 2008, aged 32, her first thought was how she was going to beat the disease.

"I was saying to my doctors, 'Oh my God, oh my God, start doing something now.'"

But her doctors suggested delaying treatment for up to 20 days.

The tumour was about 10cm in diameter at this point and lay close to her reproductive organs.

Dr Miller, who has a PhD in Medieval art history, said: "It might not be right for everyone but in my case it wasn't an aggressive form of cancer and I was told that a delay of 20 days wouldn't make any difference to the effectiveness of my treatment - whereas without the delay I would never be able to have my own children.

'Difficult conversation'

"Sometimes we can get so preoccupied by death that we forget to see the patient as a person who has a future ahead of them too."

Dr Miller and her then-partner, now husband, Justin Ward, were referred for fertility counselling immediately after she was diagnosed.

"Obviously I wasn't desperate to have children, otherwise I would have had them by then," she said.

"I was 32 at the time and I was still studying for my PHD and my husband was still studying too. We hadn't really thought about having kids, but being faced with the possibility of not being able to have them, that was very different."

Amy Miller Cancer should not define people, Dr Miller said

Cancer treatment often destroys women's eggs and leaves the patient infertile, but with early intervention eggs can be harvested and fertilised and the embryos then frozen and stored until the couple wish to use them.

The Teenage Cancer Trust said more care needed to be given to young women requiring cancer treatment that could damage their chances of having children.

However, Dr Allan Pacey from the University of Sheffield said fertility preservation was often not a realistic option if cancer treatment needed to start immediately.

Responding to a study by the cancer trust, Dr Dan Yeomanson, a consultant paediatric oncologist for Sheffield Children's NHS Foundation Trust, said there was still a need to discuss fertility issues with young patients - especially females - before treatment began, even if there were no options available for fertility preservation.

Dr Miller said: "All of a sudden we had to have this really difficult conversation. We were still getting our heads around the cancer and didn't know if I was going to survive and they were asking us if we wanted to have children together.

"That's a big decision for a couple to make.

"They take you down the adoption route essentially and talk through what would happen to the embryos if you break up, or in the event of one or both of you dying.

"But I'm so glad they did."

'Patient empowerment'

Dr Miller, who is from Kenilworth in Warwickshire, said she was thrown headlong into the medical system from the instant she was diagnosed.

"It's serious, it's immediate and it's complicated. They make appointments for you and you go. The staff are brilliant but it is a very dehumanising experience.

"Going for fertility counselling was really comforting - just having someone listen to you that's not concerned about the cancer as such, who asks about how you are feeling, is so welcome and refreshing.

"When you're dealing with cancer you don't know whether you have any future. Going through fertility treatment and creating viable embryos felt good because I knew if something happened to me, at least Justin and my family would have something of me that would survive into the future.

"I think it is so important to get counselling and have the discussions early on about the impact on your reproductive system, not only if you want to have children. It's understandable that oncologists want to focus on treating the cancer, but the cancer should not become the person.

"Making decisions about your own reproductive system is important to retaining a sense of wholeness and empowers you as a patient."

Dr Miller has now been clear of cancer for four years, having undergone surgery and radiation therapy - but she has no immediate plans to start a family.

She told the BBC she and her husband felt under no pressure.

"One good thing to come out of all this is that I don't feel guilty now [about] having children later in life because my eggs have been frozen as my 32-year-old self. As we would have to go down the surrogacy route too, there is no risk to the baby from delaying this."

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