Cancer's Impact on Fertility and How to Possibly Overcome It
- Actress Olivia Munn has reportedly married comedian John Mulaney, who has remained by her side amid her recent breast cancer journey, in an intimate ceremony in New York state.
- Munn, who chose to preserve her fertility amid treatment, was diagnosed with breast cancer despite receiving a “normal” mammogram and testing negative for the BRCA gene mutation, which increases your cancer risk. Amid treatment, which included a double mastectomy (removal of both breasts) and breast reconstruction, she also underwent a full or total hysterectomy.
- A hysterectomy is a procedure that removes part or all of the uterus (or womb), often along with the cervix, according to the National Cancer Institute. Women who receive a diagnosis of uterine, ovarian, and cervical cancer may have their cancer treated with a hysterectomy. A side effect of a hysterectomy is infertility. However, cancer patients wishing to have children can preserve their fertility by freezing eggs for use through in vitro fertilization (IVF).
- Various cancer treatments can affect both men’s and women’s fertility.
- Before undergoing cancer treatment, patients must speak to their doctors about fertility preservation if they wish to have a family in the future. Egg, sperm, and embryo freezing are common approaches to fertility preservation, but other options exist.
Munn, a mother of one who decided to freeze her eggs amid cancer treatment to keep her options open for another child, had “Law and Order” alum Sam Waterston officiate their marriage, according to TODAY.com.
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“I’m so thankful to John for the nights he spent researching what every operation and medication meant and what side effects and recovery I could expect,” Munn said, as she announced the news earlier this year.
“For being there before I went into each surgery and being there when I woke up, always placing framed photos of our little boy Malcolm so it would be the first thing I saw when I opened my eyes.”
She added that people faced with cancer should “surround [themselves] with individuals who care and support [them]” throughout treatment while also acknowledging their limits on what they can handle.
Munn was diagnosed last year with breast cancer, and underwent a double mastectomy [removal of both breasts], as well as a hysterectomy, removing her uterus, with additional surgeries to remove her fallopian tubes and ovaries (oophorectomy) to avoid taking an estrogen-suppressing drug. She was also put into a medically-induced menopause prior to the hysterectomy.
Before her surgery, Munn went through another egg retrieval process [she had already gone through several prior to her diagnosis], and produced two healthy embryos.
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Speaking to Vogue in May, she confirmed that her and her husband have “two healthy embryos.”
Mulaney also spoke with Vogue, explaining how cancer affected their relationship. He said, “Olivia and I have been through a lot of things together in the past couple years, just side-by-side, supporting each other through anything.
“And as her guy, I felt both scared and protective. Even with Malcolm in her lap and me there holding her hand, she was going to be physically fighting this disease alone.”
Olivia Munn’s Cancer Journey
“I wouldn’t have found my cancer for another year – at my next scheduled mammogram – except that my OBGYN…decided to calculate my Breast Cancer Risk Assessment Score. The fact that she did save my life,” Munn said in an earlier Instagram post.
The Breast Cancer Risk Assessment she credits for catching her breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer throughout their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine tells SurvivorNet.
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Munn’s Breast Cancer Risk Assessment score was at 37%, which led to her undergoing an MRI, ultrasound, and a biopsy, which confirmed her breast cancer.
Last February, she wanted to be proactive about her health and underwent genetic testing.
Genetic tests can be as simple as a simple saliva swab or blood sample. The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. The results help doctors tailor your treatment and are helpful for breast cancer patients.
“I tested negative for all (different cancer genes), including BRCA,” Munn said.
The BRCA1 and BRCA2 gene mutations are among the most important genes to look for in breast cancer. Together, they are responsible for about half of all hereditary breast cancers. These genes prevent cells from dividing haphazardly and uncontrollably in a person without mutations. Mutations prevent these genes from doing their job and can allow unchecked growth of breast, ovarian, and other tissues.
However, two months after undergoing genetic testing, Munn was diagnosed with Luminal B breast cancer in both of her breasts.
According to research in “Breast Cancer,” luminal B tumors are of a “higher grade” and tend to have a worse prognosis. This type of breast cancer is estrogen-positive (ER), meaning the hormone estrogen fuels it. It can also be progestogen (PR) negative, meaning it is not fueled by progestogen. This type of breast also tends to have a higher expression of the Ki67 protein, making it grow quickly. Hormonal therapy and chemotherapy are often used to treat this type of cancer.
Munn underwent a double mastectomy [surgical removal of both breasts] to treat her cancer.
When a woman decides to have a mastectomy, several factors go into that decision. Among things to consider is whether to have breast-conserving surgery such as a lumpectomy. These decisions should be made alongside your doctor by openly and candidly discussing risks vs. benefits.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
More on Fertility and Cancer
- Fertility Preservation After a Cancer Diagnosis
- Preserving Fertility During Cancer Treatment: What Are the Options?
- After A Cancer Diagnosis: Getting Fertility Hormone Injections
- How Does Chemotherapy Affect Fertility?
- Can I Have A Baby After Breast Cancer?
- New Evidence That IVF Is Linked To Higher Rates Of Breast Cancer– A Leading Expert Explains Why Women Shouldn’t Necessarily Be Alarmed
Understanding Fertility Preservation & Cancer Treatment’s Potential Impact on Fertility for Men and Women
“When a woman is diagnosed with cancer in her childbearing years, fertility preservation should be a part of the conversation, like it’s part of the treatment plan,” Jaime Knopman, MD, a reproductive endocrinologist at CCRM Fertility in New York City, previously told SurvivorNet.
“Everyone in their reproductive years should be advised of their options.”
Freezing Eggs Or Embryos: What Should I Do?
Cancer treatments like chemotherapy can damage sperm in men, and hormone therapy can decrease sperm production, according to the National Cancer Institute. Radiation treatment can also lower sperm count and testosterone levels, impacting fertility. These possible side effects of cancer treatment should be discussed with your doctor before starting treatment. For male cancer patients, men may have the option to store their sperm in a sperm bank before treatment to preserve their fertility.
This sperm can then be used later as part of in vitro fertilization (IVF), a procedure in which a woman’s egg is fertilized with sperm in a lab. The embryo is then transferred to a woman’s uterus to develop.
Just as cancer treatment can impact men’s fertility, women may also be affected. Some types of chemotherapy can destroy eggs in your ovaries, making it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the drug type and age since your egg supply decreases with age.
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
WATCH: Fertility after Cancer
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you have a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women preserve their fertility before cancer treatment by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor specializing in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment immediately and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- For women getting radiation to the pelvis, Ovarian transposition moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine treatment.
Questions for Your Doctor
If you’re wondering how your cancer treatment may affect your fertility and what options are available to you, consider asking your doctor these questions, according to the National Cancer Institute:
- Could my treatment lead to infertility?
- Are there other recommended cancer treatments that might not cause fertility problems?
- Which fertility preservation options would you advise for me?
- What fertility preservation options are available at this hospital? At a fertility clinic?
- Would you recommend a fertility specialist (such as a reproductive endocrinologist) that I could talk with to learn more?
- What are the chances that my fertility will return after treatment?
Contributing: SurvivorNet Staff
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