Yes, fertility can be preserved during treatment

No patients want to hear a doctor tell them they have cancer. When they hear that word, patients often think about the future. What will they have to do to beat it? How will it a ect their lives? How long will they have to live?

For women of childbearing age, the questions become even more difficult. Will they still be able to conceive? Do their babies have a chance of getting cancer? Will they be affected by cancer drugs? It is a devastating diagnosis. However, there have been some medical advances when it comes to preserving fertility for women who are undergoing cancer treatment. They include:

Egg freezing or cryopreservation: This is a relatively new process that may be a good choice for women who do not need to undergo treatment right away or who may not currently have a partner. Women who choose to bank their eggs take a hormone to produce multiple eggs and then wait for those eggs to mature (which may take about two weeks from the last menstrual cycle). Because that hormone can also cause certain types of cancer to grow faster, it is not advisable for women who have these types, such as certain forms of breast cancer.

Embryo freezing or cryopreservation: For women who have a committed partner and want to someday have children with them, they can have their eggs removed and fertilized by their partner’s sperm in a laboratory. These embryos are frozen and stored until the woman is done with cancer treatment. The embryo(s) can then be implanted back into the woman’s uterus. Since it may take several eggs to make sure that one is able to fertilize, survive the freezing process, and grow into a live birth, doctors prescribe a hormone to allow more eggs to mature. This leaves women in the same situation as the egg banking, with the length of time to wait for the eggs and concerns about the hormone increasing cancer growth.

Ovarian tissue cryopreservation: This new option may make sense to some women and girls who are at risk of ovarian failure from chemotherapy or radiation therapy. A surgeon removes an ovary or ovarian tissue and freezes it. Once the cancer treatment is over, the surgeon re-implants the ovarian tissue or ovary into the woman. Because the procedure is so new, it has resulted in only a small number of live births so far. It is an option to consider for girls who have not gone through puberty yet and women who have aggressive cancer that needs to be treated right away.

Pre-implantation genetic diagnosis (PGD): Another newer, more controversial procedure has been introduced for women who carry the BRCA gene mutation and are worried about passing it down to their children. Women who have the BRCA gene have an up to 80 percent chance of developing breast or ovarian cancer. They also have a 50 percent chance of passing it down to their daughters. Thanks to the complete mapping of the human genome, doctors can test embryos for the BRCA gene mutation before they are implanted in the woman. This means a woman with the BRCA gene mutation can do IVF and have their embryos tested for the gene. They can choose to only implant the embryos that do not have the BRCA gene mutation, thus reducing the risk of their children developing breast or ovarian cancer in the future. This type of genetic selection is concerning to some medical ethicists who fear that our world will end up with “designer babies.” However, for some young women with the BRCA gene mutation and breast cancer, they may feel that making sure their embryo does not have that gene mutation is the right decision.

 Fortunately for some women, fertility returns on its own after cancer treatment. Also, some cancer treatments will not even impact fertility. These two outcomes, along with the high cost of these procedures (often not covered by insurance) make it important for women of childbearing age who have cancer to discuss fertility options with their doctor.

Dr. Jennifer Shinners is an OB/GYN art Coastal Women’s Healthcare in Scarborough. She can be reached at jshiners@coastalwomenshc.com

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