TAMPA — When Geri Bell lost her breasts to cancer, she joked that at least she wouldn't need a bra. When she lost her hair to chemotherapy, she'd say how her wig made it so easy to get ready in the morning.
But when doctors recommended removing her ovaries because of a hereditary cancer risk, she had only questions. Childless and single at 36, she wanted to preserve both her life and her fertility.
"In this whirlwind of 'I need to make a decision ASAP,' this wasn't something that was exposed. It wasn't written about," she said. "There weren't any Lifetime television shows about it. I didn't know what to do."
Her search for answers four years ago led her to Tampa's H. Lee Moffitt Cancer Center and Research Institute, which was turning more attention to fertility preservation for breast cancer patients. Later this month, Bell plans to return to Moffitt as a guest speaker at its recognition as a center of excellence by Fertile Hope, a national group devoted to the concerns that she once struggled through alone.
Especially for younger patients like Bell, living through cancer often isn't enough. Survivors want quality of life too, and for many that includes children.
Rush of thorny issues
Moffitt expects its doctors to discuss fertility options whenever they diagnose cancer in woman and men of reproductive age.
But this isn't a universal practice. About half of the nation's cancer specialists fail to bring up fertility preservation with their patients, according to a study by Moffitt researchers that was published last week in the Journal of Clinical Oncology.
Much is known about how various treatments will affect cancer, but their potential effect on fertility is less clear. Teenage girls, for example, may remain fertile at the end of chemotherapy, only to experience menopause prematurely several years later.
"It's not like hair, where we can pretty much say with certainty, 'You'll lose your hair, but here's the wig shop downstairs,' " said Gwendolyn Quinn, the lead author of the study, who works for Moffitt and serves on the faculty at the University of South Florida.
Many thorny issues can come up. Should a female cancer patient store her eggs, or a fertilized embryo? Embryos are more likely to lead to a successful pregnancy, but if the woman isn't married, whose sperm does she use? When a teenage boy isn't interested in banking sperm, should his parents force him, on the assumption he may change his mind?
And how do you come to terms with all this in the brief window of time you have between a cancer diagnosis and starting treatment?
"When you're diagnosed with cancer, you might have four or five days to make these decisions," Quinn said. "They might be something you've never thought about, other than to say, 'I know I want to be a parent one day.' "
From a medical standpoint, she noted, men are more likely to become permanently infertile after cancer treatment than are women. But banking sperm is a far less complicated procedure than retrieving and storing eggs.
Family on hold
Deciding to preserve fertility is just the start. Bell's experiences illustrate the dilemmas faced by patients and physicians as cancer survival rates improve.
Bell, now 40 and living in Orlando, is still a long way from her happy ending. But she says that knowing motherhood is still a possibility has helped give her hope through her cancer struggle.
She was first diagnosed with breast cancer a decade ago, and had a second occurrence six years later. Doctors urged removing her ovaries after she was also found to have a genetic predisposition to ovarian cancer, which claimed her mother last year.
They also wanted her to have more chemotherapy, but Bell wanted to know about the effects on the rest of her body, particularly on her uterus. "I wasn't ready to give up the hope of ever having children," said Bell.
"How do you deal with that after playing, when you're a little girl, that you're going to be a bride, and you're going to have children and a family?"
She postponed further cancer treatment to have some eggs retrieved in Tampa, where Moffitt has a partnership to offer the procedure through the University of South Florida's in vitro fertilization clinic.
Bell was engaged at the time, but having doubts about the relationship. She and her fiance made two embryos together, then she decided to freeze five of her unfertilized eggs.
The pressure of working through so many decisions in a matter of weeks hastened the couple's eventual breakup, she said.
Since then, Bell has tried not to think too much about the frozen eggs that hold her dreams of motherhood. A corporate event planner, she still hopes to find a partner, and she can't afford to have a child alone. She struggles with doubts and fears. She wonders whether her cancer will remain in remission, and if her children would inherit a predisposition to cancer. She says she can only hope for good fortune and further medical advances.
She also doesn't know what to do about the two frozen embryos, which she sees as "people in holding." Bell knows that, between her age and the complexities of in vitro fertilization, her odds of getting pregnant with her frozen eggs are slim. She has thought about adoption, but longs to experience pregnancy and childbirth. "Will I ever have children of my own? I don't know. But I've been given the hope," she said. "I have that hope and that wonderment and that glee."
"And that," she noted, "is what life is all about."
Letitia Stein can be reached at email@example.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.