Fertility after Cancer
- Larissa Brown was elated to be able to give birth after having treatments for both endometriosis and breast cancer. But her second daughter had to face a heath battle of her own hypoplastic left heart syndrome.
- Breast cancer is a common cancer that has been the subject of much research, so there are many treatment options out there. Mammograms, a standard screening procedure for breast cancer, and self breast exams can save lives.
- Fertility preservation practices for women can include egg and embryo freezing, ovarian tissue freezing, ovarian suppression and ovarian transposition.
- According to our experts, people with breast cancer face unique challenges when it comes to fertility. If they need chemotherapy, their eggs could be damaged. Also, if a women's treatment calls for medication to stop specific hormones, they might not be able to get pregnant for several years or, in some instances, 10.
The 39 year old from Queensland, Australia, was ecstatic to be able to give birth after undergoing breast cancer and endometriosis treatments that she was told would could affect her fertility. Her first daughter, Emilia, now 3, was born in 2017, but problems arose when she was pregnant with her second daughter.
Read MoreStill, Brown was determined to fight for her daughter, Georgia, and ultimately decided to go ahead with the pregnancy.
“We didn’t have it in our hearts to terminate the pregnancy, and we felt like the worst people in the world for choosing to proceed, but we couldn’t give up on her,” she said. “I gave birth, gave her a kiss then they whisked her away before I had a chance to hold her.”
When she was just six days old in 2021, Georgia underwent a 10-hour open heart surgery following by a lengthy recovery after experiencing a collapsed lung.
“She looked really puffy and was in a bad way, but then she started recovering beautifully, then out of nowhere she needed more oxygen,” Larissa said. “Doctors had no idea what was wrong with her, they ran all the tests and gave her medication but she gradually became worse.”
Thankfully, a CT scan revealed what was wrong: Georgia was over-circulating and her oxygen levels were dangerously low.
“[The cardiologist] said to me: ‘I finally understand Georgia’s heart,'” Brown said. “It was such a relief.”
Before she could undergo the next surgery she was now qualified for, however, she needed antibiotics to fight an infection. Thankfully, the five-hour procedure was “simple” once Georgia was ready, and after 169 days inside a hospital, she finally got to go home.
‘I was both terrified and excited, because in hospital if we’re concerned about anything we could just hit a buzzer and a nurse would come. Now it’s all on me,” Brown said. “We’re 110 per cent grateful and are so lucky to be able to bring her home. She has a lot of catching up to do with her development but she’s getting there.”
Georgia is now 11 months old and thriving despite fighting rhinovirus twice and COVID-19 once.
“She’s an incredible baby and is always draws everyone in,” Brown said of her strong daughter.
Understanding Breast Cancer
Breast cancer is a common cancer that has been the subject of much research. Many women develop breast cancer every year, but men can develop this cancer too though it is more rare, in part, due to the simple fact that they have less breast tissue.
Screening for breast cancer is typically done via mammogram, which looks for lumps in the breast tissue and signs of cancer. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
There are many treatment options for people with this disease, but treatment depends greatly on the specifics of each case. Identifying these specifics means looking into whether the cancerous cells have certain receptors. These receptors the estrogen receptor, the progesterone receptor and the HER2 receptor can help identify the unique features of the cancer and help personalize treatment.
"These receptors, I like to imagine them like little hands on the outside of the cell, they can grab hold of what we call ligands, and these ligands are essentially the hormones that may be circulating in the bloodstream that can then be pulled into this cancer cell and used as a fertilizer, as growth support for the cells," Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, previously told SurvivorNet.
The Unique Features of Breast Cancer: Deciding the Right Course of Treatment
One example of a type of ligand that can stimulate a cancer cell is the hormone estrogen, hence why an estrogen receptor positive breast cancer will grow when stimulated by estrogen. For these cases, your doctor may offer treatment that specifically targets the estrogen receptor. But for HER2 positive breast cancers, therapies that uniquely target the HER2 receptor may be the most beneficial.
Fertility and Cancer Treatment
Infertility can be a side effect of some cancer treatments, but there are options to consider. Fertility preservation, for example, is available to women of childbearing age. Options for women include:
- Egg and embryo freezing (the most common practice)
- Ovarian tissue freezing
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
Dr. Terri Woodard discusses your options for preserving fertility after a cancer diagnosis.
No matter what course of action you choose to take, it is important that all women feel comfortable discussing their options prior to cancer treatment.
In a previous conversation with SurvivorNet, Dr. Jaime Knopman, a reproductive endocrinologist at CCRM NY, says time is precious when dealing with fertility preservation for women with cancer. In other words, the sooner the better when it comes to having these important fertility conversations with your doctor.
"The sooner we start, the sooner that patient can then go on and do their treatment," Dr. Knopman said. "A lot of the success comes down to how old you are at the time you froze and the quality of the lab in which your eggs or embryos are frozen in."
Can I Have A Baby After Breast Cancer?
When it comes to breast cancer patients specifically, there are some unique challenges for women with the disease. Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, outlines them in a previous interview with SurvivorNet:
- Young women who need chemotherapy could have their fertility significantly affected because many chemotherapy drugs can damage a woman's eggs.
- If women are on a medication to stop the hormones which feed their specific kind of breast cancer, they may not be able to get pregnant for several years in some instances 10 years.
- Many stage four breast cancers need estrogen to grow. Pregnancy is a very, very high hormonal state, so it's not recommended in these cases.
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