Planning ahead can help preserve fertility in young cancer patients.

Imagine being 22 and having your two biggest fears come true: You have cancer, and your treatment may leave you unable to have children in the future.

While you’re still coming to terms with the diagnosis, you now have to make some major life decisions. Do you want to freeze your eggs? Or should you choose a sperm donor and freeze fertilized eggs instead? Don’t forget to consider your husband’s feelings — even though he isn’t even in your life yet.

“It was so overwhelming,” says Arieana Carcieri, who found herself facing this scenario last year after being diagnosed with Hodgkin lymphoma. “I come from a big family and always wanted at least three kids. The cancer diagnosis alone was all-consuming — I didn’t anticipate the decisions I’d have to make about a future family.”

When Arieana learned that her cancer treatment could impact her ability to have children, she turned to Dr. Sara Barton, a fertility specialist at Brigham and Women’s Hospital who collaborates with Dana-Farber/Children’s Hospital Cancer Center. Dr. Barton sees many young women between the ages of 16 and 21 who are preparing for cancer treatment.

“These aren’t issues women typically think about in their early 20s, especially without a partner,” she said. “We’re asking them to make very mature, complicated decisions that are going to have a big impact on their life trajectory. A lot of girls think yes, I want kids, I want to do it. But then we have to talk about the reality of the situation and the financial cost.”

Cancer treatment can increase the rate at which a woman’s supply of eggs is depleted. Some chemotherapy accelerates the aging of a 20-something’s ovaries to that of a 35- or 40-year-old. Radiation can damage both the ovaries and the cells the uterus needs to regenerate each month, which are important to carry a healthy pregnancy.

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