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Although cancer risk is known to rise with age, the disease can strike people
at any stage of life. Cancer patients of all ages tend to be highly focused on
getting through cancer therapy, fighting the disease, and surviving cancer-free.
But premenopausal women with cancer have an additional set of concerns. Each
will be forced to ask herself the following questions: As a woman with cancer,
do I feel the same way about having children as I did before I was diagnosed? Do
I want to protect my ability to get pregnant at all costs? What can be done to
preserve my fertility through the arduous chemotherapy process? Are fertility
treatments hard to endure? Are they effective? What are my chances of getting
pregnant once I'm out of the woods? Is it worth the trouble?
Lynn Westphal, MD, Assistant Professor and Director of the Donor Oocyte Program
at Stanford Reproductive Endocrinology and Infertility Center, is a leader in
the field of fertility preservation. Dr. Westphal has worked with oncology teams
to help a growing number of women conceive after cancer therapy. Below, she
outlines women's options, both common and experimental.
What steps can a woman take to preserve her fertility before starting cancer
therapy?
A woman's treatment options will depend on the type of cancer she has, the type
of treatment she's going to receive, and how much time she has before starting
treatment. If she's going to start therapy very soon, her only option may be a
gonadotropin-releasing hormone agonist (GnRH), a medication that may ultimately
preserve ovarian function by shutting down the ovaries during chemotherapy.
Although unproven, it is believed that putting the ovaries to sleep during
chemotherapy may actually protect them. Afterwards, ovarian function may return
to normal or close to normal.
Another thing we sometimes do is freeze a woman's eggs or embryos before
therapy. If she has a couple of weeks before the start of chemotherapy, we may
discuss stimulating her ovaries, removing several eggs, and then either freezing
the eggs or fertilizing them with male sperm and freezing the embryos. This is
essentially the same as an in vitro fertilization cycle.
What factors affect a woman's chances of getting pregnant after she completes
cancer therapy?
The most important factor is her age at the time that she's receiving
chemotherapy. If she's in her late thirties or forties, it's less likely that
her ovarian function will return to normal. In addition, the type of
chemotherapy drug and the total dose are important. Some types of chemotherapy
are much more damaging to the ovaries than other types.
If preserving fertility is a primary concern, a woman may request a type of
chemotherapy that could have a less toxic effect on the ovaries.
What are the options for women undergoing radiation treatment?
Radiation can damage tissue that is in the path of the beam of radiation.
Sometimes the radiation oncologist can localize the radiation far enough down in
the pelvis so that the ovaries won't be affected. Another option is that before
the start of radiation therapy, we can surgically move the ovaries further away
from the radiation field. We can simply move them up and out of the pelvic
region.
Are there any additional fertility-preserving drugs or procedures available to
women with cancer? If a woman has already lost her ovarian function, she can get
donated eggs and have the embryo or embryos implanted into her own uterus.
There's also another highly experimental surgical procedure, involving the
following steps: A piece of ovarian tissue is removed, frozen, and then replaced
after the end of cancer therapy. Thus far, no pregnancies have resulted from
this still experimental procedure. Perhaps more promising, researchers have been
culturing ovarian tissue in the laboratory to get eggs that could be used to
fertilize embryos for implantation in the uterus.
Given the harsh side effects of most cancer therapies, how many women with
cancer are willing to subject themselves to additional treatments to help them
stay fertile?
Most patients are very focused on getting rid of the cancer, but there's a
minority who are really dedicated to preserving their fertility. There are some
women who will delay or change their treatment plans, because fertility is even
more important to them than treating the cancer. They know there's a tradeoff:
Maybe they'll have a slightly lower chance of a cure, but they'll have a better
chance of getting pregnant in the future. So there is a range in how strongly
women feel about it.
How many women actually achieve a pregnancy after cancer therapy?
You know, it really depends on the woman's individual situation. If she's young
and being treated for certain types of cancer with agents that are less toxic to
the ovary, then her fertility potential is very, very good. But if she's in her
late thirties or in her forties, her odds of having good ovarian function
afterwards are going to be much lower. Remember, by the time she's in her late
thirties, a woman has a smaller number of remaining eggs, anyway, so she may not
even have optimal ovarian function at that point.
I've had quite a few patients who have frozen embryos in the past, used them
after they went through their chemotherapy, and went on to become pregnant.
Recently, I had a patient with endometrial cancer who froze her embryos before
having a hysterectomy. Later, when she regained her health, she found a
surrogate, and had a baby boy in December.
Are you seeing more people with cancer looking for ways to preserve fertility?
Now that we're curing more cancers and more people are living longer after their
diagnosis, quality-of-life issues like preserving fertility have come to the
fore. There are many more people thinking about fertility than there were even
ten years ago. Many people with cancer don't even realize yet that there are
things they can do about it.
It's extremely important to make this information available to as many people
with cancer as possible. This is a case where patients can do a lot to educate
their oncologists, many of whom don't know much about fertility issues and what
can be done to help women keep their reproductive function.
What is your best advice for women with cancer who are committed to preserving
their fertility? How can they be proactive in their own care?
I'd recommend one very good resource - the Fertile Hope website. Fertile Hope is
an organization that was started by a woman who went through cancer treatment
when she was very young herself. The organization's primary aim is to make
cancer patients aware of things they may be able to do to help with their
fertility in the future. The site contains a list of places in the country that
freeze eggs and embryos and offer other treatments that may help in the future.
Source :
http://www.breastcancerhealth.org/breastcancer/fertility.asp