Toby Robertson is an only child. He was a toddler when his mother, Cath, received the devastating diagnosis of breast cancer, so the sibling his parents wanted to give him was not to be.
''It's an evolving process. You come to a level of acceptance over time,'' said Mrs Robertson, 42, who four years after treatment has remained free of the disease. ''My life is lovely. I'm incredibly blessed to be here and lucky to have a child, but there's always that lingering depth of grief you go through.''
Learning she might have no more children because chemotherapy could trigger early menopause was ''harder than being told I had cancer,'' said the Leichhardt mother, who was further advised against another baby because her tumour type was sensitive to pregnancy hormones.
For women diagnosed today, the prospect of future motherhood is suddenly much better.
Fertility specialists are urging breast cancer patients to investigate having eggs harvested and stored during the interval between surgery and drug treatment, following the exceptional success over the past year of a new freezing technology.
Fertility specialists are urging breast cancer patients to investigate having eggs harvested and stored.
Stephen Steigrad, the director of the Department of Reproductive Medicine at the Royal Hospital for Women, said the vitrification technique - which snap-freezes eggs so quickly damaging ice crystals cannot form - was yielding successful thaw rates of up to 80 per cent.
The chance of achieving pregnancy from stored eggs was now so good the service should be offered routinely to young breast cancer patients, Dr Steigrad said, but still relatively few were being referred. ''The answer would have to lie with the cancer surgeons and oncologists,'' he said. ''I don't know how vigorously this is raised with patients.''
Women with partners can store embryos, but for singles or those uncertain about their relationship, there have been few options. Until recently most frozen eggs did not survive thawing, leading doctors to question the ethics of proposing egg storage to psychologically vulnerable cancer patients.
Michael Chapman, the medical director of clinic group IVF Australia, agreed women should be prompted to consider egg storage, which had ''gone from a 5 per cent chance of a pregnancy to 30 to 40 per cent.''
But he said about half of breast cancer patients who sought a fertility consultation did not go ahead because they were ''so focused on fighting the disease that they don't want to delay''.
Hormonal stimulation of the ovaries to produce multiple eggs can take up to a month, potentially deferring chemotherapy. But most patients already have some delay between surgery and starting medication while their tumour pathology is analysed.
Doctors have also worried that hormone drugs to promote ovulation might stimulate residual cancer cells. But the chief executive of the Cancer Council Australia, Ian Olver, said the brevity of the treatment meant it was unlikely to be harmful.
A research psychologist at the University of NSW, Bettina Meiser, said doctors needed to overcome their prejudices and offer fertility advice to all pre-menopausal women. ''They should not make any assumptions based on characteristics such as a woman's age or whether or not she's single,'' she said.
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