WASHINGTON - A week before Carrie Lintner began radiation treatment for her cancer, doctors cut tiny holes in her abdomen and pushed her ovaries out of the way of the damaging beams.

When treating cancer in young women and men, doctors too seldom warn that some treatments that may save their lives may also destroy their fertility – but there are options that offer the chance of future children, if patients act in time.

"You do need to think about it before treatment, or else it will be too late," cautions Stephanie Lee of Seattle’s Fred Hutchinson Cancer Research Center.

New guidelines urge the nation’s cancer doctors to tell younger patients if their pending therapy puts them at risk of infertility – and quickly refer those who want to preserve that fertility to a reproductive specialist for help.

About 10 percent of the nation’s 10 million cancer survivors were diagnosed during their reproductive years, and roughly 55,000 younger than 35 are diagnosed each year.

The risk of infertility depends on the type of cancer and treatment. Numerous forms of chemotherapy, high-dose body-wide radiation or radiation aimed at the pelvis, and even some surgeries can leave patients unable to procreate.

Surveys suggest only about half of oncologists properly discuss the fertility risk, possibly because their focus is more on helping patients survive than on how they’ll spend their life-after-cancer years. Also complicating fertility preservation is that it can cost thousands, is only sometimes covered by insurance, and typically is offered only at specialized centers.

Yet studies suggest that retaining fertility is a key goal of many patients, and doctors won’t know that unless they ask, stresses Lee, who led a probe of the issue for the American Society for Clinical Oncology.

What’s available to help? Most successful are sperm banking for men, and for women, freezing embryos; ovarian-moving surgery; and for cervical cancer, surgery that spares the uterus, conclude ASCO’s new guidelines.

There are other experimental options, such as freezing and later reimplanting ovarian tissue – or highly controversial options, such as using hormones to suppress ovarian function – that patients should seek only at specialized centers or in strictly controlled clinical trials, the guidelines warn.

Consider Lintner, a dentist in Kalamazoo, Mich., whose Hodgkin’s lymphoma return in February 2003. Lymph nodes near her ovaries required radiation that would surely shut them down.

Lintner immediately hunted for ways to have a baby once she recovered. "I don’t think fertility was the main issue except for me," she says of her physicians.

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