CHICAGO — Cancer treatments can be toxic and can render many women infertile. But there is hope and that gives doctors and breast cancer patients a reason to smile.

Gudrun Wu Snyder is a breast cancer survivor and mother of two.

But it was just after her first child’s first birthday that she noticed something.

“I noticed a dimple in my right breast,” she said.

The Chinese medicine practitioner was 32-years-old at the time.

“I knew a dimple was a sign of cancer,” she said.

Diagnosed with invasive ductal carcinoma, she underwent a bilateral mastectomy and began a course of tamoxifen – a drug that dampens estrogen in the body.

“My tumor was hormone receptor positive, meaning hormones would make it grow,” she said. “It wasn’t on my top of mind whether or not I was going to have another baby/ On top of mind was whether or not I was going to live.”

But it was on the mind of her care team; Kristin Smith, Northwestern Medicine patient advocate, and Dr Daniela Matei from Lurie Cancer Center.

“We know that when fertility isn’t brought up at an initial cancer diagnosis there is a lot of regret that goes along with that for these patients in survivorship,” Smith said.

“The majority of patients who have treatable cancer can preserve their fertility,” Matei said. “The most important factor is the type of cancer they have, how treatable the cancer is, the stage.”

Advocates want patients to know their options that include a wait-and-see approach with the hope some residual fertility is maintained; medicines that put ovaries in a menopause-like state to potentially help preserve egg counts, though data behind this option are mixed; and egg and embryo freezing.

“This is a process where we put a patient through an expedited invitro fertilization cycle,” Smith said. “(It) takes about two weeks from start to finish, it’s not cycle dependent so we can really get patients in quickly get them through quickly and get them back to their treatment as needed.”

For Gudrun, it was the best course of action. Before starting drug therapy, she underwent an egg retrieval and ultimately froze embryos for later use. About two years into her treatment, her doctors allowed her to take a break and try for another baby.

“I was only allowed to go off my medication for a very short period of time so it was like, ‘This is it. This is your chance,’” she said. “So I really was so happy to be in such great hands. … I think just being able to have the opportunity to try for a second was a really, really big gift.”

It’s a gift pediatric doctors are hoping to offer even younger patients through ovarian tissue freezing.

“There are researchers all around the world and just across the street at Lurie Children’s where they are actively working on ways where we can isolate out follicles from that tissue and then grow those follicles outside the body so we can get a mature egg,” Smith said.

The process has resulted in about 200 live births.

“That’s something we are really hopeful science will catch up on,” Smith said.

“I think it’s so important to be your own patient advocate. So if there is anyone out there who is watching this now who is thinking, ‘I’m going through my own cancer treatment. Is this something I should be thinking about?’ I think it’s so important to reach out ask your doctors and see if you can find a program like that,” Wu Snyder said.

Insurance coverage for medical fertility preservation varies state to state and can be costly. In Illinois, services are covered.