TORONTO - When Kelly Knee was diagnosed with breast cancer at age 35, she chose not to have her eggs preserved prior to fertility-damaging chemo because, as she saw it, her family was complete.
"At the time I was married and we had four boys, so we were finished having a family," she said from her home in Torbay, NL. "And when you're going through cancer, you're in survival mode and all you're thinking of is 'I have to get this chemo.'"
Knee, who had surgery in spring 2014 to remove her left breast before starting chemo, had been told the powerful drugs would likely put her into menopause and bring her reproductive years to an end.
She was prepared for that. But a year later, her marriage ended and she subsequently began dating another man. Then in October 2015, Knee discovered she was pregnant.
"I was completely shocked. And I hate to say this ... but when I initially found out, I thought: 'I have been through so much, I can't do this."
But Knee said her boyfriend, never married and without kids, wanted the child. So she went through testing to make sure the fetus was developing normally, and in July 2016 she gave birth to another healthy baby boy.
"After so many children, you think you kind of run out of love. But there was so much love, my children were so involved and Jacob was just this big bundle of love that brought us together despite the cancer and the divorce," she said.
"Another miraculous thing happened — I was able to breastfeed my baby. One breast tried to kill me, while the other aided in keeping my baby alive."
While "miracle" children can happen after cancer, Toronto specialist Dr. Karen Glass said those who go through chemotherapy and hope to one day start or expand their family should safeguard their fertility by having their eggs harvested and preserved or their sperm frozen prior to chemo.
"Women will be like, 'Oh look, I'll have no problem," after hearing Knee's story, said Glass, director of fertility preservation at the Create Fertility Centre. "But she was probably above average in terms of her fertility when she started, so chemo likely only knocked her down," but not out.
"She's a super fertile lady. She already had four kids. So you've got to look at your population."
As well, her tumour wasn't estrogen-driven, unlike some other forms of the disease. Women with an estrogen-positive cancer are put on drugs like tamoxifen from five to 10 years to prevent recurrence and must go off the drug if they wish to get pregnant, due to the risk of complications to the fetus.
A study last year by researchers at Women's College Hospital in Toronto showed pregnancy does not appear to increase the risk of death among women who have had breast cancer; five-year survival rates were similar for women who did not get pregnant (88 per cent) and for those who got pregnant six months or more after a breast cancer diagnosis (97 per cent).
Like Knee, most people facing a cancer diagnosis are usually anxious to start treatment as soon as possible to increase their odds of survival.
But Glass said the process of medically stimulating ovulation in women in order to harvest their eggs or to produce embryos for preservation can be done in two weeks or less, and often it takes that long between having surgery and the start of chemo.
"As long as the patient is referred efficiently to an oncofertility specialist who knows how to manage cancer patients ... there's really not a delay in starting treatment," she said.
"If the breast cancer surgeons do the referral, because they're often the first ones to see the patient, then things go very smoothly. As soon as the biopsy comes back showing cancer, I get to see them.
"Sometimes I have their eggs out before they've even had surgery."
However, one of the challenges is making sure cancer patients who hope for future children get referred to such specialists, said Julie Easley, a social scientist whose research has focused on young people with cancer.
A 2017 report by the Canadian Partnership Against Cancer on adolescents and young adults with cancer listed referral to an oncofertility doctor as a major priority, but noted there are not enough IVF clinics across Canada to serve their needs.
Another barrier is the cost of IVF, which runs to thousands of dollars. Most provinces don't pay for such fertility-preserving interventions, and due to their age, most young people don't have private insurance that might include coverage. For those living in rural Canada, especially, the cost of travel to a fertility clinic can also be prohibitive.
Easley, who works for the New Brunswick Cancer Network in Fredericton, said adolescents and young adults given a cancer diagnosis also voice myriad psychosocial concerns related to post-cancer fertility, ranging from 'Can I even have kids after treatment?' to 'What if I do have a child and the cancer comes back? What if I die and I leave a young child without a mother or father?' There's also the element of 'What if I pass down some kind of genetics that may lead them to get cancer?'
"And if you're single and not in a relationship, what about disclosure?" she said. "How do you tell someone that you might not be able to have kids, let alone telling them that you had cancer?"
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