By Dr. Laura Meyer, RMA of Connecticut
Cancer touches the lives of almost all Americans. Up to 40 percent of people will at some point face a cancer diagnosis, so we see and feel its effects in our families and across our communities.
Take breast cancer, for instance. One in eight women will receive this diagnosis in their lifetime, making it the most common cancer in the US. While most new cases occur in those who are postmenopausal, 19% of breast cancer cases occur in younger, reproductive-aged women.
For cancer patients who still dream of growing their family, it can be overwhelming and stressful to juggle a new diagnosis and treatment options with concerns about future fertility and pregnancy.
Why Consider Fertility Preservation?
During cancer treatment, the very chemotherapy that may save a woman’s life can also damage and deplete her eggs, making future conception more difficult. The risk of infertility depends on the type and dose of medication, and the age of the patient at the time of treatment.
Furthermore, the likelihood of becoming pregnant decreases naturally as we age, and delays due to cancer treatment and recovery can increase fertility challenges.
As a Reproductive Endocrinologist, I work with newly diagnosed cancer patients to discuss options for fertility preservation, so that each woman can achieve her family-building goals. Fortunately, in the midst of a battle with this terrible, indiscriminate disease, there is hope for the future. We have many ways to help women with cancer grow their families.
Fertility Preservation Methods
Egg Freezing
Egg freezing is the process in which mature eggs are removed from the ovaries and frozen for potential use in the future. In order to freeze eggs prior to breast cancer treatment, a woman takes injectable medications to stimulate the ovaries for 10 to 14 days. The goal is to mature multiple eggs simultaneously, which will then be removed during an egg retrieval procedure and frozen in the embryology laboratory.
This process can be started very quickly and at any point in a woman’s menstrual cycle, an important consideration when a patient needs to start cancer treatment as soon as possible. For example, a breast cancer patient could complete a preservation cycle in the time period between breast surgery and chemotherapy or radiation.
Additionally, since some forms of cancer (such as breast and endometrial) are sensitive to estrogen, and a woman’s estrogen levels typically rise during an ovarian stimulation cycle, a medication called Letrozole can be given to lower the body’s exposure to estrogen for the duration of the treatment.
When a woman decides to use frozen eggs in the future to build her family, they are thawed and fertilized with sperm to create embryos, which can then be transferred into the uterus directly, or after genetic testing.
Embryo Freezing
Some women with partners will opt for embryo freezing prior to cancer treatment. The initial part of the process is the same as egg freezing, but after ovarian stimulation and egg retrieval, sperm is used to fertilize the eggs and create embryos.
These embryos are cultured in the embryology laboratory and are typically frozen at the blastocyst stage (Day 5 of the embryo’s development). Blastocyst embryos can be safely tested for chromosomal abnormalities, or even for cancer-causing genes (such as BRCA) in women that have a genetic predisposition to cancer.
Ovarian Tissue Cryopreservation
Women who need to begin treatment urgently and do not have time for an egg or embryo freezing cycle also have the option of ovarian tissue cryopreservation. Laparoscopic surgery is performed to remove part of one ovary, and this tissue is divided into pieces and frozen for the future.
When a woman wants to build her family later on, a piece of that tissue will be thawed and surgically transplanted onto her existing ovary. Some of these tissue grafts will become hormonally active, and ovulate eggs in the future.
This method was considered experimental until recently, but over 130 babies have now been born worldwide from ovarian tissue transplantation.
GnRH Agonists
During chemotherapy treatment, medications called GnRH agonists (gonadotropin-releasing hormone agonists) can be given to suppress a woman’s hormones – keeping the ovaries “quiet” in order to make the eggs less susceptible to damage.
This medication may reduce the chances of going into menopause during cancer treatment, but the degree of benefit that it provides is still a matter of debate. It is not a substitute for the other methods of fertility preservation listed above, but can be given in addition to these treatments.
Pregnancy After Cancer
Planning for Pregnancy
Deciding when to become pregnant after cancer treatment is a complex choice, influenced by many factors. The type of cancer, stage, and need for ongoing treatment all play a role in determining a safe time to conceive. It is always important for women to discuss these issues with their oncologist prior to proceeding with pregnancy.
Most of the time, they are advised to wait at least a few years after the completion of treatment before trying to conceive. If a cancer is estrogen-sensitive and long-term hormonal suppression is required, the recommendation may be to wait significantly longer.
Using a Gestational Carrier (Surrogate)
For women with estrogen-sensitive cancers and/or those taking long-term hormonal suppression to reduce the risk of cancer recurrence, another option is to build their family with the help of a gestational carrier, also known as a surrogate.
An embryo created prior to cancer treatment (or an embryo created after treatment with previously frozen eggs) can be transferred into the uterus of a gestational carrier, who carries the pregnancy but has no genetic link to the baby. This option allows for healthy, safe, family building for women who would have a high risk for cancer recurrence if they pursued pregnancy.
Other Options
Women who do not preserve their fertility before cancer treatment still have other options for expanding their family. If they do not ultimately conceive on their own, they may use a donated egg or embryo to become pregnant, or can pursue private or public adoption pathways.
Hope for Future Family Building
A new cancer diagnosis can evoke feelings of fear and uncertainty about the future. This can be particularly difficult for premenopausal women that desire to grow their families. Fortunately, women of reproductive age facing a cancer diagnosis have many options to make their dreams of motherhood a reality.
Many patients who pursue egg freezing and embryo freezing often report that the experience is hopeful and empowering during an otherwise challenging time. By exploring fertility preservation and planning for any future pregnancies prior to cancer treatment, women can keep their options open and control when (and how) they grow their families.
