Fertility Preservation Before Cancer Treatment
- Various cancer treatments can affect a woman’s fertility.
- Chemo and radiation can destroy eggs, and hormone therapy may block or suppress key fertility hormones and may prevent a woman from getting pregnant.
- However, research shows fertility preservation before breast cancer treatment at least doubles chances of giving birth after treatment.
- Doctors should bring up fertility preservation with every woman of childbearing age before she starts cancer treatment.
- Egg and embryo freezing are the most common approaches, but other options exist.
The doctors told her she'd need chemotherapy and that infertility was a likely side effect.
Read MoreHow Cancer Treatment Can Affect Fertility
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 says. "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."
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.
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.
Your 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. That's what Inverso did. She froze eight embryos.
Dr. Terri Woodard discusses your options for preserving fertility after a cancer diagnosis.
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 safely 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.
In the study from the Dana-Farber Cancer Institute, most of those people who paused ET were able to conceieve 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.
Women's Key Concerns: Money & Time
"The biggest hesitation most women have is cost because this isn't always been covered by health insurance," Knopman says.
That was the obstacle that Inverso and her husband faced. Their health insurance didn't cover the cost of freezing embryos. Ultimately, they got assistance from Fertile Hope, a Livestrong program, and used their savings to pay for the rest.
Related: Breast Cancer Survivor Giulliana Rancic Now Has a Beautiful Son
As Knopman explains, there's financial assistance available for fertility preservation. Many fertility specialists discount the cost of treatment for people with a cancer diagnosis. Charitable organizations, such as Chick Mission of which Knopman is Chief Medical Officer, help cover these costs, too.
Related: Sportscaster Erin Andrews Opens Up About Her Cancer & Fertility After Treatment
"There are a lot of programs that will help you, so don't let the cost be a barrier," Knopman says.
Many women are also understandably concerned about delaying the start of their treatment to undergo egg harvesting and freezing, which takes about two weeks.
‘Freezing eggs or embryos, what should I do?’ — Dr. Jaime Knopman explains.
"The first reaction is panic," Inverso says, "I've got to get this cancer out right away. But you should definitely take the time to at least talk to your doctors about your options. I'm so glad that I did."
Fertility clinics, Knopman assures, can get patients with cancer in for their procedure almost immediately after diagnosis.
"There's no time lag. I see patients within 48 hours of their referral. We know how to streamline this. So, we all work together as a team to get the treatment started quickly," she says. Knopman also notes that if you need cancer treatment so urgently that there's no time to harvest eggs, your doctors will tell you so.
Risks of Pregnancy After Cancer Treatment
In-vitro fertilization and embryo transfer don't always result in pregnancy, but cancer survivors seem to have the same chance at success as other women, Knopman says. However, some types of chemotherapy can have long-term consequences, for example, for the heart or lungs.
"For a patient who has had chemo, I'll refer them to a high-risk obstetrician or a maternal-fetal medicine specialist for a full workup to make sure that she is healthy enough to carry a pregnancy."
A Happy New Beginning
About six years after her breast cancer diagnosis and after a few attempts, Inverso got pregnant with not one but two babies thanks the embryos she froze before treatment. She calls them her "miracle twins." They are now six years old.
Her advice to other women before they begin a treatment that may risk their fertility?
"When you’re starting, it's obviously completely overwhelming and it feels like the end of the world, but it does get better. It’s temporary. There will be a light at the end of the tunnel and life after."
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