A diagnosis of cancer isn't the death sentence it once was, mainly thanks to more effective treatments. With aggressive chemotherapy and radiotherapy, many men and women of reproductive age are emerging out the other side, ready to resume their lives.

For some this will involve trying for a baby. After all, the National Cancer Registry (NCR) shows that about 10pc of new cancer diagnoses in 2008 were in patients under the age of 45.

But chemo and radiation are known enemies of fertility and it used to be the case that the chance of getting pregnant and having a baby after cancer were about as grim as surviving the cancer itself.

Oncofertility explores the impact of cancer and its treatment on reproductive health. It's a relatively new medical practice -- the term was first coined in 2006 -- between the specialities of oncology and reproductive medicine.

The preservation of male fertility is much less complicated than female. Most male cancer patients can bank sperm, although this must be done before undergoing the cancer treatment.

For them, the biggest hurdle to preserving fertility is the discrepancy between awareness of the issue and being referred to a fertility specialist.

Frozen

The world-famous cyclist Lance Armstrong was 25 when he was diagnosed with testicular cancer. He was advised by his oncologist at the time to have his sperm frozen. After aggressive cancer treatment, he beat the disease -- and three of his children were subsequently born using his banked sperm.

The options of fertility preservation for young female cancer patients present unique limitations. For starters, women are born with all the eggs we'll ever have and when we run out menopause begins. Chemo can initiate early menopause by affecting the ovaries' ability to make the hormones necessary in order for a woman to get her period.

Even if a woman does get her period again after treatment, her ovaries may still have been damaged.

Naomi Fitzgibbon is manager of the Cancer Information Service at the Irish Cancer Society.

"When someone is first diagnosed with cancer, it comes as a real shock," she says. "It can take a while for a treatment plan to be put in place -- sometimes a few weeks.

"This is a time when the question of fertility can come up, particularly for women who are pre-menopausal who haven't had children, or who had planned to have more children," says Naomi.

She says that when someone calls the National Cancer Helpline and is talking about their cancer, he or she might raise the issue of fertility.

"Sometimes the nurse may raise the issue if appropriate. It is a very delicate subject.

"Sometimes it just isn't appropriate. We will discuss treatment options and what treatment will affect their fertility. We can give them advice and information, and suggest questions to ask their doctor."

Naomi says the most important thing is to have the discussion.

"Years ago there weren't many options," she says. "Now there are. The main thing for women is to preserve their ovaries," she says, "and there are drugs that can do that.

"Some patients decide to delay cancer treatment in order to look at fertility options. They need to talk to their oncologist/surgeon," she says.

Affected

According to Naomi, patients' fertility is temporarily affected during cancer treatment, but that is not to say that it doesn't come back. It can take about six months to a year for periods to go back to normal once treatment has finished.

Chemo can stop your ovaries from working permanently if you are on a very high dose of drugs. Permanent infertility is also more likely in older women, who are closer to menopause age.

"The nurse will discuss options that are available and will tell them to ask their oncologist or surgeon to make a referral to the HARI (Human Assisted Reproduction Ireland) Unit at the Rotunda Hospital, Dublin. It is important that the patient gets the opportunity to speak to the experts there," says Naomi.

Naomi has seen an increase in some cancers in the younger age group, particularly women. The good news, she says, is that there is great work being done in the area of fertility.

Becky was diagnosed with non-Hodgkin's lymphoma in 2001 at the age of 27.

"It was a relief to get a diagnosis as I had been sick for a long time, and I was misdiagnosed a number of times. I was shocked initially," she says.

"The biggest thing for me was that I wouldn't be able to have children. That was the biggest blow. It was most likely, but it wasn't a definite. Chemo can send you into an early menopause.

"I didn't care about losing my hair, or any of the other side effects of chemo. I wasn't in a relationship, but I loved children and hoped that one day I'd be able to have them," she says.

There was no mention of preserving Becky's fertility at the time.

"It wasn't an option," says Becky. "I needed emergency chemo which started the next day. I went to a lymphoma conference after the treatment, and the specialist said that fertility preservation wouldn't have been an option for me as I couldn't have waited the six weeks to preserve the eggs. It only applied to a slow-growing cancer."

Becky's son Charlie was born in 2007 without any fertility treatment. Her oncologist had said that if her monthly cycle returned, it was a very good sign, so she hoped for the best. Then she got pregnant a second time and Jack was born a year ago.

"I have friends who weren't so lucky," says Becky.

Preservation

Dr Edgar Mocanu is a consultant specialist in reproductive medicine at the HARI Unit at Dublin's Rotunda Hospital.

The unit deals with approximately 250 male and female cancer/fertility cases in a year.

"Fertility preservation is extremely important to young cancer sufferers," says Dr Mocanu, "particularly as there is so much to think about when a severe diagnosis of malignancy is made.

"The question about fertility must be in every patient's mind, but not many ask it," he says.

"Furthermore, as cancer survival rates are increasing, survivor's reproductive potential will become a major medical issue in the future.

"The National Oncology Cryopreservation Centre, located in the HARI unit at the Rotunda Hospital, offers oncology appointments to all oncology referrals. Free services for males include consultation with a doctor, a counselling session, semen analysis, freeze and storage, repeat semen analysis after cancer therapy is completed, and long-term storage and counselling support," Dr Mocanu says.

"Free services for females include consultation with a doctor, a counselling session, hormonal measurement, ultrasound assessment, IVF-like ovarian stimulation, oocyte recovery, oocyte or embryo freeze, long-term storage of cryopreserved material and long-term counselling support."

Sufferers

Dr Mocanu believes that all young cancer sufferers should be asked about fertility preservation before cancer treatment, although "the treatment of malignancy always takes priority," says Dr Mocanu. "Consideration could be given, where the prognosis is excellent, to delaying cancer therapy in order to facilitate fertility cryopreservation.

"Even the opportunity to discuss the pros and cons of fertility preservation with female cancer patients is therapeutic in itself.

"One has to accept though that in many circumstances, fertility therapy is contraindicated, and cancer treatment has to take priority."

Amy Tucker from Illinois is the first cancer survivor in the United States to give birth as a result of ovarian tissue freezing and transplantation.

Dr Sherman Silber is a pioneer in fertility preservation and director of the Infertility Centre of St Louis.

Dr Silber removed one of Amy's ovaries and froze it 12 years ago when she was just 19, before radiation, chemotherapy and a bone-marrow transplant.

Amy was battling Hodgkin's lymphoma. Early last year, Amy was ready to start a family. She was married, working as a paediatric cancer nurse and had been in remission for seven years.

In January 2009, Dr Silber thawed Amy's frozen ovarian tissue and transplanted it back to where her ovary had been. After a few months, the ovary was functioning again, and by last September, Amy was pregnant. Amy, now 31, gave birth to a perfectly healthy baby boy, Grant Patrick Tucker, on May 27 this year.

I have friends and family who have separately undergone cancer treatment and fertility treatment. From what I have seen, both are very harrowing experiences. It takes a lot of strength to go through either, but to go through both within a short space of time would appear to put a lot of strain on the human condition.

However, there is nothing like hope during a very dark time, and if the hope of future fertility after cancer treatment is a light in the darkness to young cancer patients around the time of diagnosis, then this new emerging field of oncofertility is vital to future generations.

- Catherine Moonan

Irish Independent