Fertility Preservation Decisions

Episode 4: Fertility Preservation Decisions

Some treatments for serious illness can affect a patient’s ability to have biological children later in life, but there are ways to protect fertility. When a child is seriously ill, fertility preservation is a tough but important topic to address.

In this episode, Mark Brown and Kari Bjornard talk with Evan Moore about fertility preservation when he was going through treatment. An elite NCAA track and cross-country athlete, Evan was diagnosed with Hodgkin lymphoma in his early 20s. Evan discusses the honest conversations he had with his mom and fiancée about preserving fertility. Kari offers insights into the timing, steps to take, talking to your care team, and other options for having a family. The group talks about staying positive and being with the people you love.

A special thank you to our host, Mark Brown, director of Spiritual Care Services at St. Jude; our expert Kari Bjornard, director of the Fertility Program and assistant member of the Oncology faculty at St. Jude; and patient Evan Moore.

This episode was recorded August 7, 2025. Stay tuned for a forthcoming episode on female fertility preservation decisions.

Learn more about Evan’s diagnosis of Hodgkin lymphoma on St. Jude Care & Treatment and Together by St. Jude™.

Learn more about male fertility and female fertility on Together by St. Jude™.

St. Jude does not endorse any branded product or organization mentioned in this podcast.

Episode Transcript

Narrator (00:02) 
A child's diagnosis of cancer or another serious disease is difficult. Families, guardians, and loved ones experience a range of emotions and often need support related to their child's diagnosis and treatment.

St. Jude Children's Research Hospital brings you Caregiver SHARE, a St. Jude podcast. Share stands for support, honor, advise, reflect, encourage. In this series, you'll hear stories and insights directly from the experiences of St. Jude families and care providers.

Mark Brown, MDiv (00:37) 
Some treatments for serious illness can affect a patient's ability to have biological children later in life, but there are ways to protect fertility. When a child is seriously ill, fertility preservation is a tough but important topic to address.

For many, it can involve emotional, spiritual, family, and practical decisions. I'm Mark Brown, Director of Spiritual Care at St. Jude Children's Research Hospital, and in this episode of Caregivers SHARE, I'm joined by Evan Moore and fertility expert Dr. Kari Bjornard to talk about preserving fertility when a child faces a serious illness.

One quick note, this episode focuses on male fertility preservation, but stay tuned for part two, which will cover female fertility preservation. That's coming later. Hi, Kari, would you introduce yourself?

Kari Bjornard, MD, MPH (01:25) 
Hi. I'm Dr. Kari Bjornard. I am an assistant member of Oncology at St. Jude Children's Research Hospital, and I'm also the director of our Fertility Program here. I'm a solid tumor oncologist and see patients in our solid tumor clinic, but other than that, I spend a lot of time learning about as well as thinking about how our cancer treatments can actually affect fertility and what we can do for those patients who might be at risk.

Fertility preservation before treatment can offer hope for what's to come once treatment is over. And while it's a personal and complex topic, there are options available. Talking openly with your care team is the first step to understanding what your risks might be and what's actually possible.

Mark (02:06) 
Thanks, Kari. I appreciate you being with us. Evan, tell us a little about yourself and where you are in life and kind of what this illness journey has been like for you.

Evan Moore (02:17) 
Hi, thank you for having me here. My name is Evan Moore. I'm 22 years old. I study health science at Lee University. It's on the east side of the state of Tennessee, and I run cross country and track there at Lee University.

So a little bit of my backstory. I was diagnosed in January 2024 with Hodgkin lymphoma stage 2A. So I can break that down for you a little bit more. At the time of my diagnosis, I was completely asymptomatic. The only symptoms I had was a swollen lymph node on my neck. I had one on both sides of my neck. But I didn't have the usual symptoms, the common symptoms of Hodgkin lymphoma, which are nausea, night sweats, fever. I just had those swollen lymph nodes.

So the way I actually found out was I got some needle biopsies in the year before my diagnosis in 2023. And those showed nothing at the time. And so then I had a full biopsy of one of the lymph nodes on my neck. And that revealed that I had Hodgkin lymphoma.

And so the real reason that I kind of was like, I don't know, something might be off is because I was running cross country in fall 2023. And my performance was kind of taking a hit. My times weren't as good. And I actually had this hamstring injury that I was dealing with and it wasn't healing how I would expect my body to react to it. And so I kind of had this question in the back of my mind, like something might be wrong.

Which led to me getting a biopsy of the lymph node on my neck, which revealed Hodgkin lymphoma. And stage 2A just means asymptomatic. And so this started the complete journey of questions like, where am I going to get my treatment? What does my treatment look like? Which eventually led to me having the conversation of, you know, what does fertility preservation look like for me?

Mark (04:17) 
So fertility preservation is something that many of us may not know a lot about. And so, Kari, I'm wondering, what is Fertility Preservation 101 for you?

Kari (04:26) 
Yeah.

Mark (04:26) 
What do you say to families and patients when you're first having these conversations?

Kari (04:32) 
So oftentimes, from my perspective of getting the patient for fertility consults, we have a lot of individual patient factors to really consider and to think about. The first is really the safety and the clinical status of the patient. There are some patients that come in at the time of diagnosis and they are just far too sick. Their oncologist may feel like they have to start treatment immediately or there may be some other procedures and things that we have to do to figure out exactly what's going on.

That's a little bit different from the story that Evan was just telling us where he had a little bit of time as they were trying to figure out what's going on and he wasn't horribly symptomatic with a lot of other things. And that sounded like it really allowed time to have this conversation before treatment started.

The other things that we think about are really the diagnosis and the treatment plan. So knowing the diagnosis is really important in part because it does inform that treatment plan. A lot of times just by knowing what the cancer is, as an oncologist, I can already tell you a lot about likely what that treatment plan is going to look like. That being said, that's not the only information that we need. And sometimes we need what's called a staging workup.

So we heard again, Evan talking about the stage of his cancer. And that can be different for different types of cancer, but really is about has it spread to other parts of the body? You know, where kind of is it? And, you know, a stage 2A Hodgkin versus a stage 4 Hodgkin might mean very different things for the treatment. And so that's really important.

The chemotherapies themselves as part of the treatment plan is also incredibly important. Not all cancer therapies and chemotherapy drugs that we give are actually damaging to fertility. So in part, that's important for families to know if their patient or if their family member, you know, does not have a significant risk to their fertility. On the contrary side, there are some agents that we know are more damaging to either testicles in males, ovaries in females. And there can even be dose cut points where above a certain dose, we think of them as being more problematic than others.

There are other modalities of treatment besides chemotherapy. One of the other ones we think of a lot in fertility is radiation. This is very dependent on where in the body that radiation is going to be delivered. And so not every patient, even if they're getting radiation, this may not be something we have to consider. For example, a patient getting radiation to the arm, that's not the same risk that we think about for a patient, or as compared to a patient who's getting radiation to the pelvis or the abdomen, things like that.

And lastly, I'll sort of say biology and anatomy matters. This is an important aspect here. So people who have ovaries are different than people who have testicles. And there are different risk profiles depending on which organs you have in your body. And also there are different fertility preservation options available for different patients depending on that. And also differences in pubertal stages. So very young patients who have not gone through puberty and haven't reached that physical maturation, again, there may be some options available for them, but maybe not the full complement of options that we have sometimes for older patients.

And so we really use all of this different information to talk about individualized risk assessments for patients and also individual recommendations for what fertility preservations may or may not be available.

Mark (08:02) 
Thank you. Evan, so... At what point in this journey did the topic of fertility preservation come up for you? And what were your initial thoughts? 

Evan (08:12) 
Yeah, so it came up very early. So my family actually had some prior experience with some close friends of ours. And so I knew someone who was a close friend of mine who had cancer when they were a child. And so fertility preservation, because of the state that he was in. He was a lot, you know, he was at a state in his cancer where he was showing a lot more symptoms. He wasn't as healthy, unfortunately. So fertility preservation was not the main priority. That wasn't something that was mentioned right off the bat, just because the main priority was seeking out treatment and getting started on that. So it became something that was a problem to think through later. It was a topic that they had to talk through later when it could be a little bit more problematic. 

For me, fortunately, because of that experience, having the foresight, me and my mom actually talked about it very early on. And my mom has told me it's one of the first things that came to her mind when she heard that I had Hodgkin lymphoma. The first thing she was thinking through was we need to look into fertility preservation before I even really thought about it. 

But once she mentioned it and I, you know, I had thought about it, just not as like, it wasn't the first thing I was thinking through. But once she had mentioned it, we were talking about, okay, well, we probably should get an appointment to… even before I knew where I was getting my treatment or what my treatment looked like. I didn't even know if chemo is what I was getting. I wasn't thinking through that at all. I was, we were already prepared to, to do fertility preservation. And so it was something me and my mom had a very good open conversation about super early on in my diagnosis. 

Mark (09:48) 
Good. Yeah. I know that Evan, when you were diagnosed, you had a girlfriend you were very serious with, and she's now your fiancée. Congratulations. So you were already at a place in your life where you were in kind of a serious conversation with someone about how we're going to build a life together, right? So I guess it was important maybe for the two of you to talk. And I wonder if you could say a little bit about how that went and what were the things that were important about that conversation. 

Evan (10:15) 
Yeah, so... You know, even backing up a little bit in general of just getting a diagnosis, the first people you want to tell are the people that are most important to you. So other than my mom and my dad who were at the house when I got the phone call about my diagnosis, the first person I called was my now fiancée. 

And she obviously knew I was getting going through these doctor's appointments and we had heard there's a possibility of Hodgkin lymphoma. So when the news broke, yes, it was a surprise, but there was a little bit of preparation for that news, even with me and my family and her. And so when she heard that, you know, obviously she's, she was super supportive, took it in a very good way, but obviously there's a lot of emotional baggage that comes with that. 

But you know, I called her and let her know, but later on, I was actually able to fly out and see her before I even started my treatment. That was one of the things I wanted to make sure I actually was with her before I started my treatment. And I actually gave her an out of our relationship entirely. We were very serious. You know, we had talked about getting married one day. But I gave her an out, you know, that it's a, it's a hard place to be in when you're diagnosed with cancer and, you know, you feel like, at least in my position, I was like, I didn't want to have her pulled into this. That's not what she necessarily had asked for. You know, when you sign up for a serious relationship, she obviously wasn't having that. She had no part in not wanting to be a part of the journey and part of my life. And so I'm very grateful for that. 

But something that was mentioned was when I actually had an appointment for fertility preservation, that was something I let her know, like, yes, I'm doing this just so that there was this awareness. And so we were both on the same page, like, this is important to me to preserve, hopefully, the future of having a family with you, because that's something that's very important, especially even now in the last two, two-ish, three years. I've been thinking through, especially now that I have a fiancée is I want to have a family with, with her. Whether that's a, you know, having a biological kid or adopting, that's something very important to me. But, you know, having that partner there and having someone who you have that connection with definitely, the gears are definitely turning a lot more when it comes to fertility preservation. 

Mark (12:32) 
You're preserving your options. 

Evan (12:33) 
Exactly. 100%. 

Kari (12:35) 
And I would like to interject here to say. Or at least point out that, you know, Evan's talking about how this was a difficult conversation, just talking about the fertility part, but this is in the background of already having other difficult conversations about just the relationship too, but also the diagnosis. And so all of this is coming kind of at the same time, which I think highlights some of the issues with the timing and logistics for fertility preservation. 

And again, I know that we've kind of touched on that Evan had a little bit more time than some other patients might have at the beginning of their cancer journey to think about these things and to plan these things. But depending on what the options are, the window of time may be much shorter. And I didn't mention this before, but I think it's worth sort of thinking about what some of those options are and what that time window looks like. 

Because... That timeline just gets so condensed and you feel like you're in a vacuum and, you know, you're making very serious decisions one after another, what feels like kind of like a split second decision. So, you know, in talking about what options we usually present to patients, the sort of gold standard things that we often think of for males who've already gone through puberty, first and foremost is sperm banking. That usually can be done really quite quickly. And I mean, within 24 hours of identifying a patient and talking to them about whether they want to go forward with that. 

Different institutions have different capabilities. So sometimes there's limitations on weekends or potentially holidays, but that is usually one of the fastest ones that we can accomplish. For post pubertal females, we're talking about something called ovarian hyperstimulation and basically egg retrieval where we're making the ovaries mature a bunch of eggs so we can take them out and put them in the freezer for later. That can take sometimes up to two weeks to get done. And so we're talking about also in the background of potentially having other exams or medical appointments going on, potentially delaying treatment can be a little bit of a different conversation of what that looks like. 

And then there's also some other sort of more emerging or experimental technologies. Some of these include the ovarian tissue or testicular tissue cryopreservation, which means freezing. And sometimes different options aren't available at certain institutions. So depending on what kind of hospital you're seeking treatment at, you might be asked to have a consult at an outside clinic or potentially traveling within your state or even out of state for some of these options. 

So again, just highlighting how challenging the organization of not just a patient and family's thoughts and decisions, but the sort of whole... orchestration of scheduling and whatnot so we can accomplish this.  

You know, we've talked about these conversations being difficult, and you obviously had conversations, Evan, with both your family as well as your girlfriend, now your fiancée, as well as your medical providers. Was there any part of that process or those conversations that were awkward or that you wished had gone differently? 

Evan (15:40) 
Sure, yeah. I think especially with my mom, I wouldn't have described them as awkward conversations. And as I mentioned before, I think that's because there was already this background, you know, in the back of our minds, this was something we had already kind of seen firsthand with, with people that were close to us. 

I think one area that I thought about it a little bit more was having a conversation with my girlfriend at the time. Obviously it wasn't something I was just like immediately like, oh, I'm going to talk about this. Cause it is a little bit more of a, you know, it felt a little bit more awkward. We weren't, you know, we were very serious and it was something, you know, obviously later down the road we knew we were going to get married. But I didn't, I wasn't diving into like, oh, I'm going to do this and this and this is the way we're going to go about it. 

It was something I mentioned and I was like, yeah, like I'm going to go forward with fertility preservation because I care about your and I's future. Now, obviously through that, I had more conversations with my, my appointments that I had and stuff like that. But, you know, there is, there is this little sense of awkwardness depending upon who you're talking to. 

But I think in the end, I think, the main lesson that I learned from it and throughout the whole experience of just chemo treatment and, and cancer diagnosis in general is just being positive, being with the people that you love and being with them, removing the awkwardness from it and just being, a loving, caring individual. And, you know, putting... Putting everything else behind you or to the side and really focusing on your future, what's best for you and your health.  

And so in the end, those conversations were not really as awkward as you would probably initially think. I think having those conversations, you'll realize that it's a lot easier and overall better after you have those conversations. 

Mark (17:27) 
It's so important that you had the opportunity, Evan, to have those kinds of conversations with both your family and your fiancée. But we know that many people who undergo treatment for various catastrophic diseases go through that at a much earlier stage. You know, they're maybe in earlier adolescence. And so they're in a different position of having to think about how and when they may have a disclosing conversation with someone about their fertility status. 

Kari, I wondered, what kind of guidance would you offer to a younger person who's… making the kinds of decisions Evan had to make as a young adult. 

Kari (18:08) 
I would echo that these are challenging conversations and I think also normalizing that there is not a one-size-fits-all approach here. So certainly patients are going to come into that with their own background and thoughts and feelings about how they might want to tackle that. 

And here we're talking about, you know, what if there's a young person who was diagnosed with cancer and didn't have the opportunity potentially to do fertility preservation? Now they've survived their cancer, they've grown up, and they find out potentially that they're infertile. And then they have to tell a future partner that they already know this information. Or maybe they even have materials. And when I say materials, I'm talking about either sperm, eggs, etc., anything they might use to have children in the future. 

They may have them stored somewhere and they're talking about with a serious partner, how do we plan for using this? Do we plan financially for this? Do we need to think about what state we're living in for insurance coverage, things like that. And it's hard to tell an individual patient exactly when that conversation should happen and how that conversation should happen, because clearly, you know, the context will be very different depending on who the patient is, what their religious or cultural background is, also who their partner is. 

You know, I think from my standpoint, just trying to be open and trusting yourself of when the right time is to disclose that information probably seems like a right choice. But... I think other patients may need to process that with outside sources, potentially with mental health counseling or counseling through some of their religious leaders, things like that, to help them understand or tackle when to have that conversation and exactly how it happens. 

Mark (19:56) 
Thank you, Kari. So there are times when younger patients and their parents may not see eye to eye. They may have some disagreement about... whether or not to pursue fertility preservation. And that could be simply because they're not a family that very easily discusses openly more vulnerable kinds of personal decisions. 

But it could also be, as you mentioned, Kari, that they have some cultural or religious reservations that would feed into the ways they are making their choices. In those kind of situations, you know, maybe, Kari, you could say more about how you approach that and how can you or other clinicians and other support folks for our families be helpful in helping them think through some of those barriers? 

Kari (20:51) 
Right. We hope this doesn't happen very often, but certainly it has come up in my experience as well. And I think first and foremost, it's really helpful to make sure that everyone is operating with the same information. So making sure that all of the… whoever's in this sort of decision-making relationship, they're all present to hear the same information. And we're basing decisions off of that. 

In today's day and age, we all know that you can get a lot of information elsewhere, whether it's from other family members, from the internet—some of this information may be true and helpful, and some of it sometimes can cloud the idea of what actually is going on or what is actually possible. So I would say that is sort of the number one thing or place that we should start. 

Secondly, oftentimes allowing a respectful and open conversation from each party to understand what is the actual conflict here. Is there something about the procedure that we're talking about? Do we not understand why we're doing this? So that they can, one, each hear what the other party is trying to say, but also for me as the clinician or the person who's trying to mediate, how can I actually help this? Or is there a way that I can sort of see, oh, we could clear this up by doing this instead, or we could talk about this. 

And lastly, sometimes we need to bring in extra help. As you've mentioned and highlighted, some of these issues really are cultural or religious. That's not necessarily my area of expertise. And so sometimes we bring in other colleagues from the chaplaincy group. Sometimes local cultural leaders will participate in these conversations as well. 

And sometimes patients or families need to talk to, again, other mental health professionals to just help them process through sometimes whether it's grief or how to sort of tackle these difficult conversations so that we can hopefully come to a united decision. Ultimately, sometimes there are very clear situations where a patient has been very adamant that they don't want to do a certain procedure. And sometimes that can be a difficult barrier to get past. And so there certainly have been times that caregivers and patients don't always see eye to eye. 

Mark (23:18) 
That's a really good reminder that mental health professionals and other people are available to talk to. Evan, I'm wondering, did you turn to other people to talk to and find support? 

Evan (23:30) 
Yeah. So as I mentioned, me and my mom obviously had these conversations early on, but someone who was also involved a little bit behind the scenes, more with my mom, not as much with just me one-on-one, was my grandma. She actually was one of the people that was looking at places for me to do fertility preservation when I was back home in Colorado, when I had first gotten diagnosed. 

And so she was talking to my mom a lot about that. And obviously my mom was relaying all this information to me as we were having these conversations and navigating through all of this. But another thing I did is during my treatment, and this goes along with just having someone to talk to, was I had psychology appointments throughout my entire treatment. But I think that's just so important to have someone to go to, maybe even outside of your family, so you can have someone who has a little bit of a different perspective. 

It's very easy for during this experience of hearing, oh, you have this diagnosis and hearing about, oh, there might be some impact on your fertility, there's a lot of emotion around this. And as a family, it's easy for everyone to be emotional, and you should be. Emotion is good, but something I found very vital and was amazing as I look back and reflect on my time during my treatment and navigating these things was having a psychologist or a mental health professional to talk to. They were very open-minded, very reassuring, positive, and they gave me good perspectives that I wouldn't have even thought of before.  

And so, but, you know, I think the main thing is just initiating these conversations. You know, it can be awkward and hard to have these conversations. But something that I noticed was that my, you know, my grandma was involved. She was talking to my mom, which sparked more conversations and more perspectives, but it also made it easier on just my mom having these conversations or my dad. 

She was, you know, my grandma was in the background looking at places for me to do fertility preservation. And having a mental health professional to talk to, to help navigate all these emotions, was also very helpful in making the situation a lot less stressful. 

Mark (25:43) 
If a medical provider is not providing the kinds of information that a family thinks that they need and want, what kind of suggestions, Kari, would you have for that family about ways to approach that topic and to request and advocate for themselves? 

Kari (26:02) 
Yes. And I would say for me as a health care provider, it will sound easy for me to say, oh, you should just ask. The easiest way is just to ask. And most of the time, most anyone on your care team really wants to make sure your questions are answered. We want to be helpful. But sometimes it's really hard as the patient or family to have the vocabulary of how to ask about fertility or fertility preservation. Sometimes it may be that we overthink this. 

And so even just opening the door with an easy question of, I heard that sometimes cancer treatment might affect the ability to have children in the future or fertility or I heard something about pregnancy in the future. You know, any of those terms or combination of them will be just a way to get your foot in the door. And it may be that whoever you're talking to may not actually have that knowledge or that answer. But saying, is there someone that I can talk to about this? That usually will get you into the right place, and, you know, open the conversation to what those risks could be and what options there are.  

If for whatever reason your medical team isn't providing that information, it's usually not because they don't want to. It's just against all of these issues and things that are swirling around the diagnosis, the workup, the treatment plan that are sort of superseding or taking place of some of these other conversations.  

Usually your care team also just wants you to have all the information you need or your family needs to make decisions. And so, the best way to advocate for yourself is just to ask and say, I have a question. I don't know who I should direct this to, but this is what it's about. And I would just love to hear some more information. 

Mark (27:48) 
Yes. Okay. Thank you. Evan, we know that there are a lot of different ways that a person can become a parent. Biologically is one way. But in your experience, you have talked about other possibilities or considered that there would be other ways that perhaps you will become a dad. But I wonder if there are other ways that just having this experience has led you to think about becoming a parent in a different way or what it means to you to consider that future that you and your fiancée hope for. 

Evan (28:27) 
Yeah. So family is something that's always been very important to me. I think that's partially just because of how close me and my family are growing up and how my parents have parented me. So becoming a parent, you know, obviously it wasn't something I was thinking about when I was younger, but, you know, the older I've gotten and in maturity, I've, you know, that's something that I've known that I've wanted to do one day. 

And so, especially now that I have, you know, the partner that I know I'm going to spend the rest of my life with, that's something I know I want to share with her of being a parent to our kids. And as I mentioned before, whether that's adopting kids or having biological kids, I think both ways. You know, you can be a parent in a lot of different ways. I think being a parent comes down to more of the core values of what does being a parent actually mean. 

To me, it means being a good mentor, a leader, a positive figure to someone, someone that guides someone. You know, I think, you know, I've had a lot of leadership experience in my life, especially with, you know, being on teams and in college, I run track and cross country, as I mentioned. And so I've had a lot of leadership experience, and I even think that taking that leadership experience is something that's very important. Being a parent, you need to be a leader. You need to be a mentor. 

But above all, it's all really about just being open-minded and loving. And you can be open-minded and loving and a mentor and leader to a lot of different people. But when it comes to being a parent, that can be to your own biological kids or if you adopt someone. Or even, you know, if you're an uncle to your sister's kids or your brother's kids, you know, that's something you can really take to heart. You know, if for some reason you don't have your own kids one day, you can, there's lots of different areas. You can be that figure to someone else. 

Mark (30:23) 
Yeah. Thank you. Kari, when you're talking with someone whose fertility status is not known or can't be known at this point, and you're talking to them about building a family, what are the other kinds of ways you describe? We've talked a little bit about adoption, but there are other options and avenues to approach. 

Kari (30:46) 
Yes. And I think this really is an incredibly important topic, in part because even for patients that we've offered fertility preservation to, there's no guarantee that that process is even going to be successful. And even if there are materials like sperm or eggs that are in, you know, long-term storage for the future, there's also no guarantee that that's going to result in a child in the future as well. 

So I think it's important to inform patients of other options regardless of whether they chose fertility preservation or not, because realistically, not everything is guaranteed. So as you mentioned, there are options for future parenting and family building, but sometimes some individuals will just need to expand what having a family actually looks like to them. 

So this is, again, very dependent on what their future decisions are and, again, who they are, what their biology is of what their options are. So for patients who are male, for example, who are potentially rendered infertile after treatment, we're talking about things like sperm donation. There are sperm banks where you can actually purchase sperm to use for fertility treatments. 

There's embryo adoption. So these are already fertilized eggs that oftentimes couples who faced infertility, who've already had all the other kids that they want to have, are willing to donate to other couples for them to use in fertility treatments and to build their own family. And lastly, as Evan touched on, adoption as well, taking a baby or a young child into your life and raising them from that standpoint forward. 

Now, for patients who have ovaries, some of those options are the same, including embryo donation as well as adoption. There's also something called oocyte donation. These are actually eggs or unfertilized eggs that are donated, and those can be used with sperm from a partner or, again, from a sperm bank to fertilize those. And hopefully those will result in children in the future as well. 

The last thing I'll say, for many young patients who are not even ready to build their families yet, they're young enough that in the next 5, 10, 15 years, it's very unclear what the technology is actually going to be. And there may be further options that we can't even think of or don't have on the table right now that really will be options for them in the future. 

And I lastly would say, you know, these are not the decisions that typically are made right around treatment. So this is something typically, that later in life, when they are ready to actually build the family, that's when they need to start thinking about how we're going to accomplish this. So typically, the way that this comes about is that patients and whether they have a partner or not, visit a local fertility clinic and talk to them about one, whether they have any materials stored. So again, their own tissue. Or whether they are going to need to embark on fertility treatments, talking about what might be available to them at that point. 

Mark (33:53) 
Thank you. It's nice to know that there are options. There are other ways that people can build the family that they envision for themselves in any circumstance. So I guess I'm wondering from both of you, you know, what final thoughts do you want to share? Like, what did I not ask you that you are curious about? 

Kari (34:15) 
I have a couple last things that I just want to make sure that I get out there. The first is that this conversation does not need to only happen one time. So for many patients who might have this conversation again at the time of diagnosis, that is a difficult time where you're having all sorts of conversations. So sometimes it can be difficult to remember what you were actually told at the time or, you know, I think I remember giving a sample and it's stored somewhere, but where is that? And what did they tell me I could use that for? 

And so I think it's important to remember that the cancer journey really is a continuum and there are other opportunities to repeat this conversation or to have it if, say, for example, there was no time prior to starting treatment to actually talk about these issues. There are also maybe other times to readdress, are there options for fertility preservation after the fact. That can be true in certain circumstances. 

That also can be relevant if there are changes being made to the treatment plan as you're getting treatment or if there's a future relapse and you're facing a new treatment plan. And then lastly, you know, in the survivorship journey. So once all of this is over, it's another great time point to revisit this topic, in part because there may be fertility testing that we can offer to give a little bit more information about how treatment might have affected you or your child as an individual, rather than just talking about in generalities, you know, what we think may happen. And again, may just open the door to other opportunities for fertility preservation if they exist.

Mark (35:53) 
Well, Evan, do you have any final thoughts or anything else you didn't get to say that you want to say now? 

Evan (35:59) 
I mean, as I just said, I would say just take everything with a positive attitude. It's such a hard thing to get the news that you've been diagnosed with cancer. I've lived it firsthand. And it is very hard and it's hard for your family and your loved ones and your friends and anyone who's going to be affected by it. 

And so there's a lot to, to think through. There's a lot of moving parts. And one of them we've talked about here is fertility preservation, but I think just trying to be positive and be with the ones that you love and have open conversations is the best way to get through that. It's hard to do it alone. You can't do it well alone. So talking to your medical professionals in an open way, talking to your loved ones, your family, your friends, anyone that is close to you in an open, positive manner is the best way to get through this entire journey. 

Mark (36:54) 
Evan and Kari, I know that your openness and your vulnerability and the wisdom that you've shared today can mean a lot to people who are listening, people who may be dealing with their own issues of fertility. Or just simply looking for ways to stand in support of the people they care about who are struggling with infertility. Thank you so, so much for being here with us. 

Evan (37:18) 
Thank you for having me. I'm glad that I was able to share a little bit of my story, a little bit of my experience and perspective on this topic. 

Kari (37:26) 
Evan, thank you again for sharing your story with us. I think it's so meaningful to hear from someone who actually went through this. And Mark, thank you for your insights as well and for leading us through this conversation. 

Mark (37:36) 
My pleasure. 

Narrator (37:39) 
Thank you for listening to Caregivers SHARE, a podcast lovingly brought to you by Patient Family-Centered Care and Psychosocial Services at St. Jude Children's Research Hospital. Please subscribe, leave a comment, and share this podcast with others who may benefit from this support. Visit stjude.org/caregivers-share for show notes and educational links related to each episode. 

This podcast is for informational purposes only and does not render medical advice or professional services. This podcast does not establish a patient relationship between the listener and St. Jude Children's Research Hospital. The opinions expressed belong to the caregivers. Your personal experience may differ. If you have questions about individual health concerns, psychosocial needs, or specific treatment options, please discuss them with your child's medical team.  

Accuracy and availability of Caregivers SHARE: A St. Jude Podcast transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on stjude.org may be edited after its original publication. The authoritative record of Caregivers SHARE: A St. Jude Podcast episode content is the audio record. 

Season 3 Episodes