Every young cancer survivor who wants children is running full speed into a pretty tough question: Am I healthy enough to even have children? 

Part of this question is physical. After chemotherapy, radiation, and other treatments, we are worn down and often a shell of our former selves. In many cases, we aren’t even cured but living in a stable but weakened state. This question is particularly difficult for women given they must carry the baby for nine or more months. 

The other part is mental. Our life expectancy is lower, is it then ethically responsible to have children? In part because we might be leaving our partners as a single parent and also because of the possible mental strain on our child. 

Some survivors I’ve spoken with have come to answers easily. Others have taken years. There are survivors in both groups who had previously always wanted to become parents and others who could have cared less. 

There is no right answer to this question, but there is a right process. 

You need to talk with your oncologist, your partner, and a fertility specialist at a minimum. A psychologist can be helpful and so can your broader friends and family. You can’t make the decision all alone. 

My friend and neighbor Sabrina Braswell spent her 20s and 30s as a lighting designer, helping rock bands perform sold out shows in Europe, New Zealand, and everywhere in between. She really didn’t think all that much about motherhood before her breast cancer diagnosis. 

After the diagnosis, she needed to do whatever it takes to become a mom. We talk about this shift a lot walking our kids to school many mornings. We talk about ethics, religion, partnership – all of the factors that helped us get to this conclusion. 

I’m lucky to be friends with Sabrina. Our cancer journeys were very different, but our conclusions on parenting were the same.  

“I feel like I lived an entire lifetime before cancer but the only thing I didn’t have was a kid. It made me say: ‘If I survive this, I have to have a kid,’” she says. 

Not everyone has a Sabrina. 

If you don’t, I have some advice from Dr. Emeline Aviki, a gynecologic oncologist and physician lead of NYU Langone’s oncofertility program. (Disclosure: My wife works at NYU Langone. I also recently joined NYU Perlmutter Cancer Center's 22nd Annual Faces of Cancer, a program honoring the many faces of cancer at every stage of survivorship.)

Dr. Aviki says that whether you are physically able to have children after treatment is highly variable, depending on your treatment and diagnosis. And, even if you can have children, the timeline and risks associated with having a child are questions only your oncologist can lay out.   

A leukemia patient, for example, might be best waiting a year instead of six months. Some pregnancies could compromise doctors’ ability to provide a cancer cure later, and that should be discussed. 

Once you decide to go for it, you don’t need a cancer-focused fertility doctor to create embryos for you or to do in vitro fertilization. But your oncologist should be consulted. 

“It is essential that the fertility specialist gets counsel from the oncologist to move ahead," Dr. Aviki says. 

As for the mental aspects, Dr. Aviki says that she asks patients to make it as objective as possible through scenario planning. 

Example Scenario: Decide you’ll get pregnant. And then pretend your baby is one year old and you have a recurrence and need to start chemo. 

Let’s say you survive but struggle for years with additional treatments. 

Or let’s say you don’t survive after year 2. 

If you can't be comfortable with either scenario "That helps you [think about] how you might proceed,” she says, adding patients must set realistic expectations for the future. 

Aside from physical and mental questions, there’s also the question of genetics. It is a pretty simple conversation but it takes a lot of thought. 

Many cancer survivors have genetic mutations that make them more susceptible to cancer, such as the BRCA1 and BRCA2 gene or Lynch syndrome. What you need to ask yourself is whether you want your offspring to be born just like you and have a 50% chance of a mutation that increases their risk of cancer. 

Or, do you want to eliminate that risk?

“We have the technology to eliminate that risk,” says Dr. Aviki. 

Speaking of Faces of Cancer, it’s a wonderful program and I was thrilled to be asked. My session had four survivors in various stages of survivorship. We had an original song, deep personal stories and even a couple laughs. 

You can find their entire roster of Survivorship Education here.

If you are struggling with questions like: Is a support group right for me? What is my gameplan for medical care once I leave my oncologist? Or, this weird thing is happening, is it happening to anyone else? I’d suggest a watch. 

Many thanks to the team at NYU for inviting me.