Many adolescents and young adults are diagnosed with cancer during their reproductive years. Breast cancer is the most common malignancy in women, and in 15–25% of cases, patients are premenopausal at the time of diagnosis. In fact, about 7% of them are below the age of 40.
The good news: advances in cancer therapies have allowed for successful treatment and amazing survival rates.
However, one unfortunate side effect of life-saving treatments like radiation and chemotherapy is potential damage to the patient’s reproductive potential. Specifically, this may include damage to the ovaries and uterus or testicles.
Some young women may experience cycle irregularity and, even more commonly, early menopause. Young men may have complete loss of their sperm production. Any damage that does occur is dependent on the drug and dose, and is also related to the patient’s age at the time of treatment.
For women with a cancer diagnosis, freezing eggs or embryos (if the patient has a partner) is currently the best option for preserving their fertility prior to chemo or radiation.
Patients who opt for this route will use fertility injections for 8 to 12 days to increase the number of eggs in that cycle. Ultrasounds and blood tests to measure estrogen levels are performed during this 8 to 12 day process. This allows the doctor to adjust the dose of the fertility shots and to determine the best day for the egg harvest.
The eggs are harvested in the operating room. Anesthesia is given through the patient’s IV so that she is not awake and does not feel pain during the procedure. A vaginal ultrasound is used to harvest the eggs. There are no incisions. Typically the egg harvest lasts about 10 minutes. After the egg harvest, the eggs or embryos are frozen and can be thawed at a later date, when the patient is ready to start a family.
In patients with breast cancer, Letrozole (an estrogen blocker) is also used along with the fertility injections.
A medicine designed to temporarily stop ovarian function may be used with chemotherapy in an effort to “protect” the function of the ovaries.
First, your oncologist or breast surgeon must determine the stage of cancer and the appropriate order of treatment. Often this may involve surgery first, followed by chemotherapy and radiation. However, in some cases, chemotherapy is the first step.
Fertility preservation options should be offered by your oncology team, who will also need to clear you for treatment. We encourage oncologists to refer their patients at the initial diagnosis.
Timing is of the essence here. Make time to meet with a fertility specialist quickly to see if fertility preservation is an option. It’s important that any fertility preservation treatments you choose to undergo won’t cause significant delay to your cancer treatment.
At CARE Fertility, we help to get patients in quickly for evaluation. We also initiate treatment as soon as possible - often within 24 hours of the initial consultation. Typically, stimulation and harvesting of a patient’s eggs can be completed in 12-14 days.
Our facility is open almost every day of the year in order to serve our patients in the best way possible. We work closely with their oncologists and surgeons to accommodate these patients during this extremely stressful time.
For patients who might not have had the opportunity to freeze eggs prior to starting chemo or radiation therapy, we recommend monitoring your “egg count” (ovarian reserve) to help determine your options for the future.
This testing will involve a vaginal sonogram to measure the size of the ovaries and count antral follicles. Antral follicles represent eggs that are available for the near future. Blood tests such as AMH (anti-Mullerian hormone which is made by the ovary and measures your “egg count”), FSH (follicle stimulating hormone which is made by the brain and causes follicles/eggs to grow each month) and estrogen levels are also helpful in assessing egg reserve.
It’s important to remember that you may still have options, even if you weren’t able to freeze your eggs and your current egg reserve is low. Talk to your fertility specialist for advice about other treatment options that are best for you.
For patients with breast cancer, special considerations must be made due to the hormonal receptor status and possible genetic implications related to breast cancer.
Ovarian stimulation, which is necessary for egg retrieval, might cause the proliferation of breast cancer cells. To prevent this, your fertility specialist will modify your stimulation protocol.
We must also consider the impact of any future pregnancy on your risk of cancer recurrence, as well as your future ability to carry a pregnancy and how soon after treatment it is safe to do so. The use of a gestational carrier can also be considered for women unable to carry.
We are fortunate to work with LiveStrong and various pharmaceutical companies to help alleviate the costs of stimulation medicines for cancer patients. There are also local cancer foundations with grants available to those who qualify.
At CARE Fertility, we also offer IVF at a reduced price for our cancer patients to make this treatment affordable for patients without insurance coverage.
We understand how frightening a cancer diagnosis can be. We also know that early treatment and intervention is key to survival. The doctors of CARE Fertility work as a team with your surgeons and oncologists to find options that preserve your fertility and provide hope.
After all, we not only want you to survive cancer, but also have a high quality of life after cancer - which includes the ability to have a family when you’re ready. We believe in you and your future!