Fertility & Moving Forward After Cancer
- Olivia Munn, 44, has just welcomed her and her husband’s newborn daughter via gestational surrogate. The actress’s daughter’s birth is certainly a milestone event as it follows recent battle with hormone receptor-positive (HR+) breast cancer.
- She’s had both her breasts removed, a hysterectomy, removing her uterus, as well as surgeries to remove her fallopian tubes and ovaries. After preserving her fertility and undergoing an egg retrieval, she is now taking medication to help prevent cancer recurrence.
- In some cases after cancer treatment, women may have difficulty giving birth to a child or they may be unable to at all. Having someone else carry their baby, like Munn, may be an option, either through surrogacy or a gestational carrier.
- Women are encouraged to talk with their doctor about how their cancer treatment may affect their fertility and what options make sense for them to preserve their fertility beforehand.
Munn, who chose to freeze her eggs while undergoing breast cancer treatment and also has soon-to-be three-year-old son named Malcom, took to social media this week to commemorate her new bundle of joy.
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Expert Cancer & Fertility Resources
- Fertility Preservation After a Cancer Diagnosis
- 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
- After A Cancer Diagnosis: Getting Fertility Hormone Injections
She continued, “Words cannot express my gratitude that she kept our baby safe for 9 months and made our dreams come true.”
“I am so proud of my little plum, my little dragon for making the journey to be with us. My heart has exploded. Méi (pronounced may) means plum in Chinese 梅.”
Munn was hit with a breast cancer diagnosis last year, and ultimately 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.
Prior to surgery, Munn went through another egg retrieval process [she had already gone through several prior to her diagnosis], and produced two healthy embryos.
Olivia’s Breast Cancer Journey
Munn’s breast cancer diagnosis emerged despite receiving a “normal” mammogram and testing negative for the BRCA-gene mutation, which increases your risk for breast and ovarian cancer.
At the suggestion of her OBGYN, the “X-Men” actress underwent a Breast Cancer Risk Assessment, which helps determine a woman’s probability of getting breast cancer. Her results called for additional screening, which revealed she had an aggressive form of cancer in both of her breasts.
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“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 Instagram post, shared in March.
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 over the course of 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.
Munn underwent genetic testing to better understand her cancer risk. 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.
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 it is fueled by the hormone estrogen. 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. Luminal is one of several types and is distinguished by its molecular makeup.
Understanding Fertility Preservation
“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?
Some types of chemotherapy can destroy eggs in your ovaries. This can make it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the type of drug and your age—since your egg supply decreases with age.
“The risk is greater the older you are,” Knopman explained. “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.”
If your cancer treatment includes surgery in which both ovaries are completely removed, then IVF will likely be needed to help get pregnant.
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 key 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 are having a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you for sure whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
Dr. Terri Woodard Discusses Options For Preserving Fertility After Cancer
Research shows that women who have fertility preservation prior to breast cancer treatment, in particular, are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Options For Preserving Your Fertility Before Cancer Treatment
Most women who preserve their fertility before cancer treatment do so by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor who specializes 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 your 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 less common approaches:
- Ovarian tissue freezing, an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment right away and don’t have time to harvest eggs.
- 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.
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 pause endocrine therapy to try to get pregnant—and they did not have worse short-term recurrence rates than people who did not stop ET (endocrine therapy). In the study from the Dana-Farber Cancer Institute, most of those people who paused ET were able to conceive and deliver healthy babies.
Of course, your doctor will be able to help you understand your unique circumstances and which path, such as pausing endocrine therapy, is right for you.
Surrogacy and Gestational Carriers
In some cases after cancer treatment, women may have difficulty giving birth to a child or they may be unable to at all. Having someone else carry their baby may be an option, either through surrogacy or a gestational carrier.
According to the National Cancer Institute, a surrogate pregnancy is “a type of pregnancy in which a woman carries and gives birth to a baby for a person who is not able to have children.”
“In a surrogate pregnancy, eggs from the woman who will carry the baby or from an egg donor are fertilized with sperm from a sperm donor to make an embryo,” the institute explains.
“The embryo is implanted in the uterus of the surrogate mother, who carries the baby until birth. Surrogate pregnancy may be an option for men or women who want to have children and have had certain anticancer treatments, such as chemotherapy or radiation therapy, that can cause infertility.”
As for a gestational carrier, the institute describes this person as “a woman who carries and gives birth to a baby for a person who is not able to have children.”
“Eggs from an egg donor are fertilized in the laboratory with sperm from a sperm donor to make an embryo. The embryo is implanted in the uterus of the gestational surrogate, who carries the baby until birth. The gestational surrogate (or carrier) is not genetically related to the baby and is not the biological mother.”
If you or someone you know is deciding on whether or not to go the route of surrogacy or gestational carrier, it’s important to know that each state has different laws and it may be necessary to speak with an attorney before moving forward.
Questions to Ask Your Doctor
If you’re facing cancer treatment and wondering about your fertility preservation options, here are some questions you may consider asking your doctor:
- How do you expect my treatment to affect my fertility?
- Are there specialists I can talk to about my fertility preservation options?
- Is it safe for me to preserve my fertility before treatment?
- What resources are available to help me pay for fertility preservation?
- What mental health resources are available to help me cope with this?
Contributing: SurvivorNet Staff
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