Alabama embryo ruling may have devastating effect on cancer patients

2/25/2024, Washington Post

A cancer diagnosis often comes with a host of difficult decisions, including what to do about the impact of treatment on a person’s fertility. Many individuals grappling with this dual burden turn to in vitro fertilization (IVF) as a way to preserve their reproductive options.

That’s why cancer patients and oncologists are expressing shock and anxiety about the recent ruling by the Alabama Supreme Court that frozen embryos are considered children under the law.

The ruling is already having a chilling effect on IVF clinics in the state. Worries are mounting that other states could adopt similar rulings that would impede fertility medicine for people, including many cancer patients, who say assisted reproductive technology might be their only way of having a family after treatments.

“We’re leaving a lot of young men and women to deal with the long-lasting effects of the cancer treatments, and some of those effects could be infertility and premature menopause,” said Deanna Gerber, a gynecologic oncologist at NYU Langone Perlmutter Cancer Center who is a triple-negative breast cancer survivor.

“It’s the responsibility of the oncologist to think about … not just treating the cancer, but to think about the long-term effects that these treatments can have on the patient’s life, and quality of life.”

Madeline B., 33, said she cried when she heard the news of the Alabama court ruling. She describes feeling overwhelmed and upset but said the ruling didn’t surprise her.

The Texas resident, who asked to be identified by her first name only for privacy reasons, underwent fertility treatments following a breast cancer diagnosis in 2019 and has one frozen embryo stored in case she decides to pursue IVF. She said that going to rallies and events with her mother growing up gave her a firsthand view into the antiabortion movement.

“I grew up in Catholic school, and my mom is a Catholic activist, so I have been very familiar with this kind of fetal personhood movement for a long time,” Madeline said. But she noted that individuals within the movement, including her mother, often have trouble reconciling their antiabortion beliefs with their support for fertility treatments — including her own.

“They can’t quite connect the cognitive dissonance that exists between the pro-life views and what they imply,” Madeline said.

How cancer treatments affect fertility

Madeline B., a cancer patient who opted for fertility treatment, stands in her home In Dallas. (Nitashia Johnson for The Washington Post)

Recent studies have shown rising cancer rates among young adults, particularly in cases of colon and breast cancer. While cancer rates have declined for individuals over age 65, there has been a significant increase in diagnoses among those under 50, with the most substantial uptick observed in the 30 to 39 age group, according to a study published last year in JAMA Network Open.

Cancer treatments, such as chemotherapy, radiation therapy and surgery, can have a significant impact on fertility in both men and women. Chemotherapy drugs are designed to kill rapidly dividing cells, including cancer cells, but they can also harm healthy cells in the body, including those involved in reproductive functions.

In women, chemotherapy can damage the ovaries and reduce the number of viable eggs, leading to infertility or premature menopause. Similarly, radiation therapy directed at the pelvic area can damage the reproductive organs, causing infertility or complications during pregnancy.

In men, cancer treatments can also affect fertility by damaging the sperm-producing cells in the testes. Chemotherapy and radiation therapy can reduce sperm count, impair sperm quality or even cause temporary or permanent infertility. In some cases, cancer treatments may lead to hormonal imbalances that affect sperm production.

Many physicians today say that egg and embryo freezing can be used as safety nets for people with cancer in case they decide to have a family in the future.

The first IVF baby was born in 1978 in England. Since then, approximately 2 percent of babies born each year in the United States arrive via IVF, according to the Centers for Disease Control and Prevention.

It’s unclear how many of those IVF babies are born to cancer survivors. But a 2020 study published in JAMA Oncology tracked Swedish cancer patients for two decades and found that 6 percent of those women opted for fertility preservation, which included banking embryos or eggs or preserving ovarian tissue before they started cancer treatments. Approximately 2 percent of those patients then used the products of their fertility preservation.

Gerber, of the NYU Langone Perlmutter Cancer Center, said that despite the rise in cancers among young patients, cancer is also being cured at a much higher rate. She added that when patients hear they have cancer, their future fertility is usually not top of mind. The Alabama ruling only exacerbates the mental health challenges they will face in dealing with future fertility decisions.

“They’re getting a cancer diagnosis, and then we’re telling them you need to start chemo in a few weeks, and then in the next few weeks just go get your eggs frozen,” Gerber said. “And so they’re making these decisions under extreme conditions and don’t have time to think about the political implications of the decisions they’re making.”

Ripple effects of Roe

TikTok influencer Amanda Butler is undergoing treatment for breast cancer and froze her eggs in the hope of having a family in the future. (Barbara Davidson/The Washington Post )

Brett Davenport, a fertility specialist and founder of the Fertility Institute of North Alabama in Huntsville, said he was shocked when the news broke about the Alabama ruling, but he isn’t as concerned about the legal implications for cancer patients in the state.

“If a cancer patient came to me today, I would not alter my treatment of them in any way,” Davenport said, “because I would obviously tell them about what just happened, and they would have to make [their] decision.”

Still, some patients in states with more liberal laws fear what might happen if similar rulings trickle into other parts of the country. They say that lawmakers need to understand the effect such decisions could have on all kinds of people.

“It’s the same stories that you’re hearing from lawmakers after Roe v. Wade, saying, ‘Oh, I didn’t think it would impact this or that’ … [but] they’re making decisions for others,” said Robin Watkins, 41, who underwent fertility treatments to have her twin boys.

Watkins, who lives in California, says fertility treatments are the reason she is alive today. In 2017, when she went in for an ultrasound to start her IVF process, the provider found an irregularity in the imaging that turned out to be a mass on her ovary.

When she got a diagnosis of ovarian cancer, she described the steps that followed as “chaotic.” After MRIs, CT scans and surgeries, her ovaries were removed, but she was able to keep her uterus intact because there were no signs that the cancer had spread there.

Based on her experience, Watkins said she was devastated by the news that at least two clinics in Alabama have halted embryo transfer while they navigate the legalities of the new ruling.

“I can’t imagine that these people who are looking to have this opportunity and are in the middle of it just have to stop,” Watkins said.

While the Alabama ruling only applies to embryos, some patients fear that the laws could keep expanding and affect fertility-assisted treatments overall, including procedures such as egg retrieval.

Amanda Butler, 34, retrieved and froze 25 eggs because she is undergoing chemotherapy for breast cancer. She said she hopes to have children in the future, and because of her BRCA2 gene mutation, which carries a higher risk for breast cancer, she will genetically test her embryos. But Butler is worried that the Alabama ruling could impede those plans.

“I just think that this is a ripple effect from overturning Roe v. Wade, where people didn’t think that it was going to have bigger consequences, and now it is,” Butler said. “IVF is going to be even less accessible because of the legal consequences that could occur.”

In recent years, egg freezing has increased sharply among women overall, not just women undergoing cancer treatments. The Society of Assisted Reproductive Technology estimates that egg-freezing cycles rose from 16,786 in 2020 to 24,558 in 2021.

Allison K. Rodgers, a board-certified reproductive endocrinologist, obstetrician and gynecologist and director of education at Fertility Centers of Illinois, said getting a cancer diagnosis and then having to face the choice of fertility preservation can be an overwhelming experience for many people.

“There’s already so many limits to accessing care. There are stigmas, costs and insurance,” Rodgers said. “Something like this is going to unfortunately hurt patients who are desperately trying to have a family.”

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