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Fertility, sexual function and cancer treatment: Help for cancer patients and survivors

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By Mindy Loya

Terri Woodard, M.D., says her practice at MD Anderson hasn't yet produced any babies.

But that isn't her only measure of success. It's been less than nine months since Woodard started offering consultations to patients who seek guidance on fertility testing and treatment options for fertility preservation through the Oncofertility Consult Service housed within Gynecologic Oncology and Reproductive Medicine.

Along with Andrea Bradford, Ph.D., she's offering patients comprehensive resources for sexual health and reproductive function. Both services lead with conversations.

"Just having a conversation during an initial consultation doesn't commit anyone to fertility treatments or counseling sessions," Woodard says. "But it means a patient can make an informed choice about whether to seek further services, and it means a lot to patients to know they have options where their fertility and intimate relationships are concerned."

Starting the conversation about cancer and reproductive health
Thanks to advances in cancer treatments, patients are living longer. But those same lifesaving cancer treatments can take a heavy toll.

"We recognize that people don't just go back to being 'normal,' says Bradford, who points to the long-term impacts that chemotherapy, radiation, major abdominal and pelvic surgeries, and hormone therapies can have on patients' sexual function, body image and fertility.

But sexual and reproductive health aren't always high on a patient's list of questions for his or her oncologist. 

"It can be difficult when you're dealing with a cancer diagnosis to think about intimacy or make plans for the future -- some patients just want to focus on their immediate treatment plan," Woodard says. "Many people are nervous and have never talked about these issues, but just getting the conversation started removes some of the barriers to treatment," Bradford adds. 

And, she says, that's the beauty of having her and Woodard on campus -- the onus is no longer on the primary provider.

"Primary doctors just have to ask a few initial questions, but then send the patient to us to have the longer, more in-depth conversation."

Improving sexual function and preserving fertility for cancer patients and survivors
Bradford and Woodard will see patients of any age, although Woodard's services are primarily for those of "reproductive age" -- which includes women from adolescence to their 40s and men of all ages.

Bradford treats women and will see them alone or with their partners, depending on their needs. She focuses on improving sexual function and breakdowns in sexual expression in relationships. She offers an initial consultation and follow-up treatments, if necessary, and also referrals to practitioners in her field for patients who can't come to MD Anderson for ongoing services.

Bradford says her most profound success stories are from people who stopped having sex because of pain or other reasons and were able to resume following treatment.

"Many patients have told me that intimacy helped both partners accept the diagnosis and helped the patient feel less guilt for becoming ill," she says.

Woodard treats men and women and operates through a partnership with Baylor College of Medicine, where all fertility preservation procedures occur. She offers a range of fertility services, including egg and embryo banking and experimental procedures such as ovarian tissue freezing.

She also offers fertility testing for survivors who would like to know if past treatments have affected their ability to have children.

Both offer their services before, during and after cancer treatment. Many of the patients they've worked with have struggled with fertility or sexual health issues for years. But Woodard would prefer to see patients prior to their treatments.

"People who can potentially have their fertility disrupted deserve to have this conversation before that happens," Woodard explains.

Empowering patients to talk more openly about fertility and sexual function
The clinicians work closely with providers to match their style and deliver a consistent approach as part of a multidisciplinary team. And both are working to empower providers and patients to talk more openly about sexual function and reproduction.

So while Woodard hasn't been here long enough to see any babies result from her practice, she's had some patients go through ovarian stimulation. She says that many of the patients she sees ultimately decide not to pursue fertility treatments.

"But they've told me how happy they are to have had the discussion and hear that they can look forward to life after cancer -- and that's just as rewarding for me," Woodard says.

A longer version of this blog post originally appeared in Messenger, MD Anderson's bimonthly publication for employees.

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