The ruling has already had a chilling effect on IVF clinics in the state. Similar rulings in other states have raised concerns that they could hinder fertility treatment for people, including many cancer patients who say assisted reproduction is the only way to start a family after treatment. There is.
“Many young men and women will be dealing with the long-term effects of cancer treatment, some of which include infertility,” said Deanna Gerber, a gynecologic oncologist at New York University Langone Perlmutter Cancer Center. “This may include early menopause and premature menopause.” Center, a triple-negative breast cancer survivor.
“The oncologist's responsibility is not just to treat cancer, but to think about the long-term impact of these treatments on the patient's life and quality of life.”
Madeline B., 33, said she cried when she heard the news of the Alabama court's decision. Although she said she was overwhelmed and upset, she said the verdict did not surprise her.
The Texas resident, who asked to remain anonymous for privacy reasons, was diagnosed with breast cancer in 2019, underwent infertility treatment, and has one frozen embryo in storage in case she chooses IVF. are doing. She grew up attending rallies and events with her mother, so she was able to see the anti-abortion movement firsthand, she said.
“I grew up in a Catholic school and my mother is a Catholic activist, so I've been familiar with this kind of fetal personality movement for a long time,” Madeline said. But she said people who are part of the movement, including her mother, People, including herself, often struggle to reconcile their anti-abortion beliefs with their support for infertility treatments.
“They are unable to fully reconcile the cognitive dissonance that exists between pro-life views and what they imply,” Madeline says.
How cancer treatment affects fertility
Recent studies have shown that the incidence of cancer, particularly colon cancer and breast cancer, is increasing in young adults. A study published last year in JAMA Network Open found that while cancer rates among those 65 and older are decreasing, the number of cancer diagnoses among those under 50 has increased significantly, with the most notable increase occurring between 30 and 30. It has been observed in the age group of 39 years.
Cancer treatments such as chemotherapy, radiation therapy, and surgery can have a significant impact on the fertility of both men and women. Chemotherapy drugs are designed to kill rapidly dividing cells, such as cancer cells, but they can also damage healthy cells in the body, such as those involved in reproductive functions.
In women, chemotherapy can damage the ovaries and reduce the number of viable eggs, potentially leading to infertility and early menopause. Similarly, radiation therapy delivered to the pelvic area can damage reproductive organs and cause infertility and complications during pregnancy.
In men, cancer treatments can affect fertility by damaging sperm-producing cells in the testicles. Chemotherapy and radiation therapy can reduce sperm count, reduce sperm quality, and cause temporary or permanent infertility. In some cases, cancer treatment can disrupt hormonal balance and affect sperm production.
Today, many doctors say freezing eggs and embryos is available as a safety net for cancer patients should they decide to start a family in the future.
The first IVF baby was born in England in 1978. Since then, about 2 percent of babies born each year in the U.S. are born through in vitro fertilization, according to the U.S. Centers for Disease Control and Prevention.
It is unclear how many of these IVF babies are born to cancer survivors. However, a 2020 study published in JAMA Oncology followed Swedish cancer patients for 20 years and found that 6 percent of the women saved embryos or eggs or used ovarian tissue before starting cancer treatment. It turned out that she had chosen to preserve her fertility, such as by preserving her pregnancy. Approximately 2 percent of those patients were using fertility preservation products.
Gerber, of New York University's Langone Perlmutter Cancer Center, said that even though cancer is on the rise among younger patients, cure rates are also much higher. She added that when she hears a patient has cancer, future fertility isn't usually top of mind for her. The Alabama ruling will only exacerbate the mental health challenges they will face when dealing with future fertility decisions.
“We tell them they have a cancer diagnosis and they need to start chemotherapy within a few weeks and then freeze their eggs within a few weeks,” Gerber said. “So they're making these decisions under extreme circumstances and they don't have time to think about the political implications of the decisions they're making.”
Brett Davenport, a fertility specialist and founder of the North Alabama Fertility Institute in Huntsville, said he was shocked when news of the Alabama ruling broke, but that the state's legal system for cancer patients He said he was not too concerned about the impact.
“If a cancer patient came to me today, I would not change their care in any way,” Davenport said. “Because I'm obviously going to tell them what just happened, and they have to.” [their] decision. “
Still, some patients in states with more liberal laws are concerned about what will happen if similar rulings trickle to other parts of the country. They say lawmakers need to fully understand that such decisions can affect all kinds of people.
“It’s the same story we’ve been hearing from members of Congress since then. Roe v. Wade “Oh, I didn't think it would affect this or that…” [but] They're making decisions for other people,” said Robin Watkins, 41, who underwent fertility treatment to have twin boys.
Watkins, who lives in California, believes infertility treatments are the reason she's alive today. In 2017, when she went for an ultrasound to start the IVF process, her health care provider noticed an abnormality on the image that turned out to be a lump on her ovary. .
When she was diagnosed with ovarian cancer, she described the aftermath as “chaotic.” After her MRI, CT scan, and surgery, her ovaries were removed, but there was no sign that the cancer had spread to her uterus, so she was able to leave her uterus intact. It's done.
Based on his own experience, Dr. Watkins expressed shock at the news that at least two clinics in Alabama have halted embryo transfers while the state assesses the legality of the new ruling.
“I can’t imagine people in the middle of it having to just stop and take advantage of this opportunity,” Watkins said.
Although the Alabama ruling only applies to embryos, some patients are concerned that the law could continue to expand and impact all assisted fertility treatments, including procedures such as egg retrieval. .
Amanda Butler, 34, had 25 eggs collected and frozen as she was undergoing chemotherapy for breast cancer. She said she wants to have children in the future and because she has a BRCA2 gene mutation that puts her at high risk for breast cancer, she plans to have the fetus genetically tested. But Butler said she worries the Alabama ruling could thwart those plans.
“I can only assume that this is a ripple effect of turning it upside down.” Roe vs. WadePeople didn't think it would have a bigger impact, but now it does,” Butler said. “The potential legal implications will make IVF even less accessible.”
In recent years, egg freezing has rapidly increased, not just among women undergoing cancer treatment, but among women as a whole. The Assisted Reproductive Technology Association estimates that egg freezing cycles increased from 16,786 in 2020 to 24,558 in 2021.
Alison K. Rogers, a board-certified reproductive endocrinologist, obstetrician-gynecologist, and director of education at the Illinois Fertility Center, says that faced with the choice of fertility preservation after a cancer diagnosis. , says it can be a difficult experience for many people.
“There’s already a lot. Access to care is limited. There’s stigma, there’s cost, there’s insurance,” Rogers said. “Unfortunately, this will hurt patients who are desperately trying to start families.”
