Fertility After Cervical Cancer
- Marissa Jaret Winokur, an actress and singer known for her memorable role as Tracy Turnblad in Broadway’s “Hairspray,” was diagnosed with cervical cancer at age 27 and worried it took away her ability to have children.
- Winokur, now 50, had her son via surrogacy, highlight the need for accessible, expert information on fertility preservation and family planning options for women facing cancer. SurvivorNet is proud to provide those resources.
- Many people fighting cancers particularly cancers that affect reproductive parts, i.e. cervical cancer, ovarian cancer, testicular cancer decide to freeze their eggs or their sperm as a way to preserve their fertility prior to cancer treatment.
- Fertilized embryos can then be implanted in the woman at a later date.
- And in some cases, women may have difficulty giving birth to a child or they may be unable to at all. Having someone else carry their baby may be an option, either through surrogacy or a gestational carrier.
- Women are encouraged to talk with their doctor about how their cancer treatment may affect their fertility and what options make sense for them to preserve their fertility beforehand.
But Winokur, like so many other women, had dreams outside of her job too – like being a mom. And when she was left without a uterus, she worried her chances of having kids were gone.
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“In 2000 I was living in L.A., going back and forth to New York, working with the Hairspray producers, but they hadn't given me the part yet. I was back in L.A. when my gynecologist's office called. My routine Pap smear was ‘off’ and I had to have a biopsy,” Winokur told the magazine.
“A few days later I was in my apartment when I got the call. I was in shock, but my family and friends rallied around me. Within days part of my cervix was removed.”
Winokur admitted feeling as if she “couldn't tell anyone at work because they still weren't sure I was right (for ‘Hairspray’).”
“I wasn't going to give them a reason not to give me the part,” she explained. “My sister made me a padded leotard because I'd lost so much weight. When I returned to L.A. a week later, they told me the cancer had spread and I would have to have a hysterectomy.”
Managing Fertility and Cancer
Thankfully, Winokur pushed through, constantly telling herself, “I’m going to be Okay,” and ultimately was given the “Hairspray” role after her second surgery.
Winokur, who also spoke to Coping Magazine about her cancer diagnosis and how she was able to have a child via surrogacy after cancer, noted how a routine Pap test was what revealed her cancer diagnosis.
“When you get a diagnosis of cancer people assume you aren't going to be healthy enough to do a show, so I didn't want anyone to know about my diagnosis because I knew I was going to be able to do it,” Winokur told Coping Magazine. “I wasn't going to let cancer get me down.”
Winokur ended up having her uterus removed during a hysterectomy to take out the tumor and ultimately didn’t need to undergo chemotherapy.
After happily receiving news that the cancer was gone, and her ovaries were unharmed, she headed back to New York City to take the stage in “Hairspray,” which debuted in August 2002.
As for having a child after cancer, Winokur’s son Zev Isaac Miller was born via surrogacy on July 22, 2008, something the Broadway star dubbed “completely a miracle of modern science” as she didn’t know she could have children of her own after a hysterectomy.
Surrogacy is a process in which eggs from a woman are fertilized with sperm in a lab to make an embryo, which is then implanted in the womb of a surrogate mother until birth.
Recounting how her friend informed her of surrogacy as an option, Winokur said, “I felt like I was in a sci-fi movie because I had no idea what could be done. I had no idea they were able to retrieve eggs.”
Since her ovaries were still intact following the hysterectomy, doctors were able to retrieve Winokur’s own eggs and fertilize them with her husband Judah Miller’s sperm, allowing for a surrogate to carry their child.
Speaking about her son, Winokur said, “He is everything. I have always wanted to be a mom, and it was devastating when I thought that I wasn't going to be able to have a baby. But just as devastating as that was, motherhood is ten times better than I ever thought it would be.”
She added, “My story is one of hope I want young women who are faced with a hysterectomy to know that they can have children. They do have options. There are many different ways to become a mom.”
A few years back, Winokur took to Instagram to celebrate her cancerversary and inspire others not to give up.
RELATED: Young Women With Cancer Who Want Children Do Not Get The Info They Need: Study
“If you have just received horrible scary news about your health or someone you love is sick, please look through my photos on Instagram and see what life after cancer can look like!” she urged.
“Build your army and fight your war, and bask in the sunlight of your success after.”
Understanding Cervical Cancer
Cervical cancer, the disease Winokr battled, begins in the cells lining the cervix the lower part of the womb (uterus).
Treatment options for cervical cancer include surgery, chemotherapy and/or radiation therapy.
We don't know the cause of Winokur’s cancer.
We do know though that HPV (human papillomavirus), a sexually-transmitted virus, causes more than 70% of cervical cancer cases. However, other risk factors like smoking can make you about twice as likely to get cervical cancer as those who don't smoke.
Should I Give My Kids the HPV Vaccine? A Leading Doctor On Why She Says ‘Yes!’
Preserving Fertility During Cancer
Many people fighting cancers particularly cancers that affect reproductive parts (cervical cancer, ovarian cancer, testicular cancer) decide to preserve their fertility before treatment to have the option later of having children.
RELATED: Fertility Preservation After a Cancer Diagnosis
It’s important to note that some cancer treatments can damage fertility:
- Chemotherapy can destroy eggs in the ovaries
- Radiation to the pelvis can damage eggs or the uterus
- Hormone therapy may block or suppress key fertility hormones and may prevent a woman from getting pregnant
- Surgery may remove key reproductive organs, such as the ovaries
Fertility preservation is a preventative measure for people who are facing these treatment options and may still want to have children down the road.
Most women who preserve their fertility before cancer treatment do so by harvesting their eggs and having them frozen or fertilized with sperm to make an embryo, which is then frozen.
After you finish your cancer treatment, a doctor who specializes in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and your eggs to create embryos in vitro and transfer them to your uterus.
In a previous interview, Dr. Jaime Knopman, a reproductive endocrinologist at CCRM NY, says that time is of the essence when it comes to fertility conversations with your doctor.
Fertility Preservation After a Cancer Diagnosis
Dr. Knopman says, “The sooner we start, the sooner that patient can then go on and do their treatment. A lot of the success comes down to how old you are at the time you froze and the quality of the lab in which your eggs or embryos are frozen in.”
Freezing Eggs or Embryos, What Should I Do?
“Oftentimes, we just do what we call a ‘fast start,'” Dr. Knopman explains. “We start them no matter where they are in their menstrual cycle. Because of that, it can sometimes take a bit longer than it would for traditional IVF stimulation. But all in, you're never really talking about more than two weeks.”
Another concern for women may be the financial commitment needed to preserve your fertility or whether insurance will cover the procedures.
As Knopman explains, there's financial assistance available for fertility preservation. Many fertility specialists discount the cost of treatment for people with a cancer diagnosis.
Charitable organizations, such as Chick Mission of which Knopman is Chief Medical Officer, help cover these costs, too.
"There are a lot of programs that will help you, so don't let the cost be a barrier," Knopman says.
The Emotional Impact of Hysterectomies
Treatment paths for cervical cancer may vary depending on the stage of the cancer and whether or not a woman wants to maintain her fertility. Like Marissa Jaret Winokur, a hysterectomy could be the best option for cervical cancer treatment.
RELATED: Fertility Breakthrough A Breast Cancer Survivor Gives Birth After Her Eggs Mature in a Lab
However, it's not the best option for everyone, and there is much to consider since it can result in total infertility.
Adjusting to Life after Hysterectomy What To Expect, And How To Cope
Dr. Jeanne Carter, a sexual psychologist at Memorial Sloan Kettering Cancer Center, told SurvivorNet in a previous interview that hysterectomies may have a positive or negative emotional impact depending on a patient's relationship with the body part that is removed.
“Having those parts removed can be very devastating for them, especially in some of our young patients who might have wanted those organs for reproductive options and may have to build families in different ways,” Dr. Carter said.
“Any time a woman loses part of her body, it's what that part of the body symbolized to them that really affects how they feel and adjust to it.”
Surrogacy and Gestational Carriers
In some cases after cancer treatment, women may have difficulty giving birth to a child or they may be unable to at all. Having someone else carry their baby may be an option, either through surrogacy or a gestational carrier.
According to the National Cancer Institute, a surrogate pregnancy is “a type of pregnancy in which a woman carries and gives birth to a baby for a person who is not able to have children.”
“In a surrogate pregnancy, eggs from the woman who will carry the baby or from an egg donor are fertilized with sperm from a sperm donor to make an embryo,” the institute explains.
“The embryo is implanted in the uterus of the surrogate mother, who carries the baby until birth. Surrogate pregnancy may be an option for men or women who want to have children and have had certain anticancer treatments, such as chemotherapy or radiation therapy, that can cause infertility.”
As for a gestational carrier, the institute describes this person as a “woman who carries and gives birth to a baby for a person who is not able to have children.”
“Eggs from an egg donor are fertilized in the laboratory with sperm from a sperm donor to make an embryo. The embryo is implanted in the uterus of the gestational surrogate, who carries the baby until birth. The gestational surrogate (or carrier) is not genetically related to the baby and is not the biological mother.”
If you or someone you know is deciding on whether or not to go the route of surrogacy or gestational carrier, it's important to know that each state has different laws and it may be necessary to speak with an attorney before moving forward.
Questions to Ask Your Doctor
If you’re facing cancer treatment and wondering about your fertility preservation options, here are some questions you may consider asking your doctor:
- How do you expect my treatment to affect my fertility?
- Are there specialists I can talk to about my fertility preservation options?
- Is it safe for me to preserve my fertility before treatment?
- What resources are available to help me pay for fertility preservation?
- What mental health resources are available to help me cope with this?
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.