SINGAPORE - Bank relationship manager Hedy Ling has many questions about her inability to bear children. Was it due to her two cancers or the chemotherapy she underwent? Can other cancer survivors go on to have children?
She had Hodgkin's lymphoma at 14, went through chemotherapy and recovered. She was diagnosed with thyroid cancer when she was 31, had her thyroid removed and is now on life-long medication.
After getting married at 32, she tried in vain to start a family despite spending at least $30,000 on in-vitro fertilisation and other procedures. Doctors have told her she has extremely low ovarian reserves.
What she wants to know is this: Why are cancer patients not made more aware that they can freeze their eggs to be used post-recovery?
Ms Ling, 39, says: "Parents should just ask their child to freeze their eggs or sperm. It's like piano lessons - you just make your kids do it."
Responding to a SundayLife! article, When A Child Has Cancer (Aug 25), she wrote to say she wanted to share her story "because I want families to prepare their stricken children in all ways possible. I wish there had been an avenue to freeze my eggs then."
In her case, her aunt and parents made the decision for her.
Says Ms Ling, who is married to account manager Andrew Teo, also 39: "I was only 14. Their biggest concern then was to save my life. Fertility was secondary."
Also, 25 years ago, freezing an egg was too costly for her bus driver father and housewife mother, she adds.
For instance, egg removal and freezing in a private hospital costs about $6,000. Ovary tissue removal and storage may hit $17,000 today.
The National University Hospital charges $1,000 for egg freezing. These exclude the six-figure sum for cancer treatments.
Cryopreservation - freezing sperm, egg or ovarian tissue before chemotherapy - is an option for patients who want to have children when they recover.
Hospitals that SundayLife! approached, including KKH and NUH, say this procedure has a low take-up rate.
Is it cancer or chemotherapy that affects fertility?
Since 2004, the KKIVF Centre at KK Women's and Children's Hospital had an egg freezing service for the ill, including for breast or ovarian cancer patients. But the centre's director and senior consultant, Dr Sadhana Nadarajah, says "only a handful" have used the service.
It is a similar picture at the National University Hospital (NUH) Women's Centre.
Professor P.C. Wong, head and senior consultant of the division of reproductive endocrinology and infertility, says only 30 men and eight women have opted to freeze their sperm or eggs in the past five years or so. They were mostly leukaemia, lymphoma and breast cancer patients.
Hospitals here allow egg-freezing only on medical grounds. Dr Sadhana says: "We do not freeze eggs for women who want to preserve 'younger and healthier' eggs so they can postpone child-bearing."
Is it cancer or chemotherapy that affects fertility?
Dr Christopher Chong, 49, of Chris Chong Women and Urogynae Centre says that both can make people barren. He adds that cancer in the genital organs, for instance, affects not only the sperm and egg quality but also intercourse.
"Away from the reproductive organs, it indirectly affects fertility by lowering a person's health and immunity, leading to poorer sperm and egg quality," he says.
Dr Soh Shui Yen, KKH's consultant of the haematology-oncology service, says: "The more chemotherapy a patient receives, the more fertility will be affected." However, she adds that fertility "may not be reduced to zero" and some cancer survivors go on to have kids.
NUH's Prof Wong, 61, says few patients consider cryopreservation because of a "lack of awareness". He adds: "It's also likely that when a patient is diagnosed with cancer, the anxiety he feels while undergoing treatment and coping with illness may take precedence over thoughts about his subsequent fertility."
Dr Ann Tan of the Women & Fetal Centre, an obstetrician and gynaecologist, says "oncologists can create greater awareness" by highlighting the freezing options.
Dr Suresh Nair, who subspecialises in advanced fertility treatments, says the cost of cryopreservation, not covered by insurance, may put people off it.
He says: "A breast cancer patient may be asking, 'Am I going to live to realise this need?'"
NUH's Prof Wong says a healthy couple can expect a 20 to 30 per cent chance of having a child, using frozen sperm and a 5 to 10 per cent chance using frozen eggs. The estimates are "based on limited data" available. And it is "premature" to discuss success rates in conception using frozen ovarian tissue as the method was available worldwide only in the past five years or so.
But parents whose teenagers have cancer and who have the means should "clearly" consider cryo- preservation, says Dr Nair.
He adds: "Cancer therapy today is life- saving. Child cancer patients survive to adulthood, which means they may want to have babies later." Advancements in medical science can salvage fertility, he says.
He practises at Gynecology Consultants Clinic & Surgery, which is likely one of the first in Singapore to use a process called vitrification in 2008.
Vitrification was pioneered by Dr Masashige Kuwayama, hailed as a legend in the field of cryobiology. The process flash-freezes an egg in a special liquid so fast that the tissue or cell has "no time to form ice crystals that can damage" it.
It then takes on a "glass state" when dipped in liquid nitrogen. To get it back to life, the egg is warmed rapidly.
Says Dr Nair: "The chance of getting a good embryo after fertilising the vitrified egg with a sperm is as good as if it were a fresh egg."
Such hopes aside, 16-year-old Nur Amirah Amir, who had a rare, malignant tumour near her heart at 14, says she is "half-hearted" about such options.
Amirah, who is the second of four children of a cargo coordinator father and housewife mother, says: "Half of me wants to say yes because I like children and want my own family. But the other half is worried that my children may inherit my cancer genes."
Meanwhile, Ms Ling jokes that though she has adopted a mongrel, the maternal instinct still "hits me once in a blue moon".
But her husband, Mr Teo, says: "Life still has a purpose. If you don't have kids, then make the best of what you have."
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