I’ll be on Tamoxifen, how does that impact my fertility?
While Tamoxifen itself does not damage your reproductive health, most women are prescribed this medication for five years. Its possible to get pregnant while taking Tamoxifen, but its not safe for a fetus. Depending on your age when you start diagnosis could mean that at the end of five years, you are significantly less fertile simply because the aging process. This does not take into consideration the potential impact chemotherapy has had on your reproductive health.
I’m 31-years-old, single and BRCA+, should I preserve my fertility?
The BRCA genetic mutation leaves women at higher risk for breast and ovarian cancer. Doctors recommend patients who are BRCA+ have their ovaries removed between the ages of 35 and 40. The first dip in fertility occurs at age 27 with severe decline at age 35. The older a woman is, the lower her ovarian reserve. Fertility preservation is a good option for those who are carriers of the breast cancer genetic mutation and the younger a woman is when she does egg retrieval, the healthier her eggs will be and the higher the number of eggs she will retrieve.
What are my fertility preservation options?
There are several ways to preserve ones fertility before you begin cancer treatment. The most common approaches require stimulating the ovaries with drugs to mature multiple eggs. Below is a table that briefly describes your options:
What’s involved in stimulating my ovaries?
Standard stimulation requires a 10-12 day period of time where you self-administer hormone injections into your abdomen. Your doctor will draw blood and perform a vaginal ultrasound every other day to monitor your progress. Two days before your egg retrieval procedure, you will use a trigger injection to signal to your ovaries it’s almost time to release the eggs. Just before ovulation would happen, your fertility specialist will perform the egg retrieval procedure.
How many eggs will I retrieve?
Each woman’s body is very different. Some women already have low ovarian reserve to begin with and therefore, may retrieve fewer eggs. Many women in their twenties will retrieve over 20 healthy eggs. Typically, the older a woman is, the fewer amount of eggs she will retrieve and the lower the egg quality. Your reproductive endocrinologist (fertility specialist) can help you with realistic expectations for your body.
Can I start the injections at any time?
No. You must start the stimulation on day one or two of your period. This often complicates a breast cancer patients timing with treatment. It’s imperative to receive a consult with a fertility doctor as soon as you can. Most patients can wait four to six weeks to begin their cancer treatment. Some oncologists will not want to delay treatment based on your specific diagnosis. We know its all overwhelming and stress the importance of pursuing fertility preservation on the rest of your life.
What is egg retrieval like?
Egg retrieval is a minor surgical procedure that takes about 20 minutes to complete and is outpatient. You will be anesthetized and unable to work for just a day or two. There is typically not much pain or discomfort associated with the procedure, cramping is normal.
Can I do anything during chemotherapy to protect my ovaries?
Ovarian Suppression is an option, though little research has been done to validate this method. Using a GnRH-a (Gonadotropin Releasing Hormone analog) injection, the ovaries are temporarily shut down during chemotherapy in the hopes that the follicles will be protected from the chemo.
I have a hormone sensitive breast cancer. Can I still do standard stimulation?
Many women with hormone sensitive breast cancers have successfully completed fertility preservation with standard stimulation. This is a personal decision and should be discussed with both your oncologist and fertility specialist. Some factors to consider may be diagnostic stage, timing of treatment and prognosis. Fertile Action believes every woman touched by cancer has the right to become a mom and should take the right action appropriate for her. There are two options available for women who choose to not use standard stimulation.
Using Letrozole or Tamoxifen to stimulate the ovaries is a new technique that may protect the breast from the effects of a surge in estrogen.
In Vitro Maturation is also an option where no stimulation is required. Doctors retrieve 5 to 20 immature eggs and then mature them in the lab over 24 to 48 hours. They can then be frozen, combined with sperm to create embryos, and then frozen. This method is considered experimental, but may be a great option for breast cancer patients.
Can I do anything after chemotherapy to improve my ovarian function, uterine lining or egg quality?
Some women pursue Chinese Medicine before, during and after treatment to protect and improve their reproductive health. Treatments include acupuncture and herbs that are safe to take while receiving chemotherapy.
What if I am infertile after cancer treatment?
Egg or embryo donation, surrogacy and adoption are all options if a woman is left infertile or when pregnancy poses a health risk.
Can I talk to someone directly about all this?
Please call 877-276-5951 or visit fertileaction.org. We can connect you to fabulous women, our Fertility Angels, who can help you navigate the fertility preservation process.
How do I qualify for your financial aid program?
The only criterion for our program is a cancer diagnosis or a diagnosis for the BRCA 1 or 2 genetic mutations.
What are the next steps I should take?