Prior to starting chemotherapy, I was asked whether I wanted to be a mother one day.
Having just received a life-altering diagnosis of cancer a week earlier, my potential for motherhood had not been on my mind — especially not with the more acute, pressing matters of impending hair loss, whether I would need to take time off from college and, of course, whether I would even live to have such an opportunity to consider. I was 20 years old.
So much of one’s life course is altered following the delivery of the three short words: “You have cancer.” For myself, this included my decision to spend my career advocating for children as a pediatric physician.
Cancer drains. It demands to be seen, felt and consumed. I spent my last semester of college balancing chemotherapy, a full course load, my part-time job and my medical school application. Every three weeks on a Friday, I drove myself to the hospital to spend the afternoon receiving chemotherapy, allowed myself the weekend to recover and then returned to classes the following Monday. I was barely holding myself together, but in retrospect I needed the sense of consistency, of control.
When the pandemic hit and classes moved online, I counted this a small blessing for myself. Moving back to my family’s home allowed me to recover from chemotherapy in comfort and privacy.
I wore a wig for more than a year. This was one of the hardest struggles I endured. I became cognizant of how much my hair meant to me — after I lost it. For many women, our hair is our crown. At school, I’d stand in front of the bathroom sink meticulously checking my wig to make sure the hairline was as inconspicuous as possible.
Anxiety crippled me, fearing that everyone could see right through me, that they could see what I was going through. I have never struggled with self-love as much as I did during cancer treatment.
Chemotherapy alone has a plethora of side effects, but one unexpected, and often overlooked, is the possibility of iatrogenic infertility. Iatrogenic infertility is infertility induced by medical treatment.
Cancer treatment does not always cause infertility; however, iatrogenic infertility is still an associated risk. Many cancer patients turn to assisted reproductive technologies for fertility preservation options prior to chemotherapy, which often include gamete retrieval and freezing, which is a two-week process consisting of daily injections and medications, concluding with a time-sensitive procedure.
However, in most states, these services are considered elective and not covered by insurance. The average price of egg retrieval for cryopreservation in the United States costs about $10,000-15,000. This excludes medications, which range from $2,000-$6,000, and the annual storage fees of the genetic materials, which can cost anywhere from $300-$500 a year. It is a colossal burden to ensure the possibility of having children in the future following cancer treatment.
Currently, 19 states have legislation for fertility preservation coverage. According to Resolve: The National Infertility Association, the range of coverage varies by state; some include the collection and preservation of sperm, unfertilized oocytes (eggs) and ovarian tissue, while others include, in addition, the storage of these unfertilized genetic materials.
In Nevada, however, there is no such legislation. Cancer patients and their families must pay these costs in full should they desire to pursue these procedures.
In early 2020, I underwent this process myself. I learned how to give myself these time-sensitive shots daily. Two days after the procedure, I started my six-months-long chemotherapy treatment.
Later in 2020, I joined the Nevada Fertility Advocates. Since then, we have done so much to promote policies that make it possible for people like me to seek fertility care.
This legislative session, I am honored and excited to work with Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) as we persevere in this journey and take up this fight once again. I support her in vitro fertilization protection bill and I encourage members of the Nevada Legislature to take action and help us make change.
For cancer patients, sometimes all we want is to retain as much normalcy as we can, to have a sense of a healthy, promising future. And for those of us who want it, our futures should include the possibility to have families.
Cancer already robs us of so much. It doesn’t need to take this away from us, too.
Kendahl Servino is a resident pediatric physician training in Arizona. She completed her Bachelor of Science in biological sciences at UNLV, and her medical degree at UNR School of Medicine. As a lifelong writer, she has several publications of narrative pieces related to her cancer experience, including in the Journal of Clinical Oncology.
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