Within weeks of getting diagnosed with cancer, Ishtar Samano was already tallying her losses.
asserted
Samano → diagnose → losses
She was just 21 when doctors told her she had advanced Hodgkin lymphoma, forcing her to drop out of her London, Ont., college.
asserted
she → tell → college
The gruelling treatment left her too exhausted to keep up with friends.
asserted
treatment → leave → friends
Soon she was unable to walk into the hospital without help.
asserted
she → walk → help
She lost her appetite, then her thick, waist-length hair.
asserted
She → lose → appetite
After two failed attempts, doctors still believed they could treat the cancer, but it would take a risky stem cell transplant.
uncertain
it → fail → transplant
That’s when Samano learned the treatment could threaten her fertility.
uncertain
treatment → ’ → fertility
“It was very hard to hear,” Samano said.
asserted
Samano → hear → ?
“It felt like cancer was throwing away my future.”
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cancer → feel → future
For young cancer patients, the diagnosis is just the first blow as they navigate a devastating disease.
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they → navigate → disease
Beyond survival, experts say fertility is an urgent concern, yet too many patients still miss out on the chance to have a biological family.
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patients → say → family
Canadian guidelines recommend all cancer patients of reproductive age receive counselling on fertility preservation before treatment.
asserted
patients → recommend → treatment
But research suggests only about half report having that conversation, though many therapies can harm reproductive organs.
uncertain
therapies → suggest → organs
Ovarian tissue cryopreservation through Mount Sinai and SickKids has become an option for patients as young as 1.
asserted
cryopreservation → become → 1
Ovarian tissue cryopreservation through Mount Sinai and SickKids has become an option for patients as young as 1.
asserted
cryopreservation → become → 1
As more hospitals introduce specialized cancer programs for younger adults, there are signs family planning is becoming part of treatment plans.
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planning → introduce → plans
But experts say greater awareness is needed, especially as researchers track a worrying global increase in early-onset cancers.
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researchers → say → cancers
Dr. Jennia Michaeli, a reproductive endocrinology and fertility specialist at Mount Sinai Fertility Clinic in Toronto, said it’s critical that fertility preservation becomes a pillar of oncology care.
asserted
preservation → say → care
She said survivors who weren’t offered fertility protection tell her they feel robbed and suffer lasting grief.
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they → say → grief
“It’s irreversible and it often changes the course of a person’s life.
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it → ’ → life
Samano first experienced unexplained fatigue in the spring of 2025.
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Samano → experience → 2025
She was enrolled in the pre-health sciences program at Fanshawe College but soon struggled to keep up.
asserted
She → enrol → College
In May, after switching to a less-demanding program, Samano developed back pain so severe it disrupted her sleep and noticed swollen lymph nodes in her groin.
uncertain
it → switch → groin
Samano went to her family doctor but said her symptoms were dismissed.
asserted
symptoms → go → doctor
When the pain persisted, she went to her local hospital’s emergency department.
asserted
she → persist → department
Diagnostic imaging and bloodwork suggested she had cancer.
uncertain
she → suggest → cancer
“When I heard the doctor say, ‘This may be lymphoma,’ I immediately just felt numb,” Samano said.
uncertain
Samano → hear → ?
A few weeks later, doctors confirmed Samano had advanced Hodgkin lymphoma and admitted her to Victoria Hospital, part of London Health Sciences Centre (LHSC), for emergency treatment.
asserted
Samano → confirm → treatment
Samano said she was told the chemotherapy could harm her ovaries, but agreed with her hematologist there was not enough time to pursue fertility preservation.
uncertain
chemotherapy → say → preservation
“When you’re facing a challenge like this, you just want to get better,” she said.
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she → face → this
“I didn’t want to delay my treatment.”
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I → want → treatment
Over the next few months, doctors tried two different chemotherapy regimes, but both failed.
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both → try → regimes
Immunotherapy cleared the cancer but Samano also needed a stem cell transplant.
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Samano → clear → transplant
Samano recalled Dr. Uday Deotare, LHSC’s assistant director of the blood and marrow transplant program, explaining that the high-dose chemotherapy in preparation for the transplant had significant fertility risks.
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chemotherapy → recall → risks
While the chemo would eradicate the cancerous stem cells in her bone marrow, it would also severely damage her ovaries.
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it → eradicate → ovaries
The chance of becoming permanently sterile following a bone marrow transplant is about 60 per cent, Deotare said.
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Deotare → become → transplant
Samano said Deotare encouraged her to think of her future and connected her with the hospital’s adolescent and young adult cancer program.
asserted
Deotare → say → program
Because she was so ill, Samano didn’t have enough time to undergo standard egg retrieval, which can take weeks.
asserted
which → have → weeks
Instead, she had ovarian tissue cryopreservation, a new option for Ontario patients.
asserted
she → have → patients
In early 2026, three weeks before her stem cell transplant, Samano had one ovary removed.
asserted
ovary → have → transplant
…and 25 more, not listed.
The Aporia
