Recently, a widely-publicized study appearing in the Journal of the American Medical Association revealed the incidence of advanced staged breast cancer in women aged 25 to 39 has been steadily increasing over the past several decades. While overall the rate of advanced breast cancer in this young age group remains low, it raises a number of concerns about future fertility for these women of reproductive age. As breast cancer survivorship continues to climb, women need to balance decisions about cancer treatment with considerations about life after treatment, including how they might build or expand their family. Women need to be educated about the potential loss of fertility due to cancer treatment, but more so about the options for fertility preservation. Focusing on the prospect of a full, rich life after cancer helps to provide hope and offer a sense of control at a time when life feels most out of control.
First and foremost, women need to understand that they are born with their complete egg supply. As the years pass, there is a steady decline in number and quality of eggs, until very few eggs remain, resulting in the cessation of regular periods, ‘menopause.’ Certain chemotherapeutic agents, including alkylating agents used to treat breast cancer, will hasten this process. Even if your period resumes after completion of chemotherapy, you may have lost a large portion of your permanent egg supply. This is known as depletion of the ovarian reserve and can lead to earlier than normal menopause. The risk is greater in older women (aged 38 and above) because at that age, the egg supply is already naturally depleted.
How can a newly diagnosed breast cancer patient take control of her reproductive options prior to commencing treatment? I encourage women to see a fertility doctor, a reproductive endocrinologist, and get a baseline test of their ovarian reserve prior to initiation of treatment and again after treatment. Make sure to tell your oncologist that you are interested in having children, and in preserving your fertility to whatever extent is possible without interfering with the efficacy of your cancer treatment. Often, your oncologist can suggest an alternative treatment plan that is either less toxic to your ovaries, or a plan that allows for sufficient time to complete a cycle of fertility preservation (egg or embryo freezing) with a reproductive endocrinologist.
Fertility clinics that offer egg and/or embryo freezing for cancer patients often have a system set up that allows them to see cancer patients within 24 hours of initial diagnosis. In addition a cycle of egg or embryo freezing can be completed within about 14 days. These clinics many times offer financial discounts to patients undergoing cycles for fertility preservation prior to cancer treatment, and there are online resources that can guide patients to free or discounted fertility medications. Resources you might consider include:
- Alliance for Fertility Preservation
- Bonei Olam
- Caporal Assistance Network
- Fertile Action
- Fertility Authority
- Fertile Future, a California Cryobank Program
- Fertile Hope, a LIVESTRONG initiative
- Heart Beat
- Resolve
- Tinina Q. Cade Foundation.
- Oncofertility Consortium
- Verna’s Purse
If your oncologist doesn’t bring up the topic of fertility preservation, you should ask him or her for a referral to a fertility doctor. Many times your oncologist and reproductive endocrinologist will work together as a team to coordinate your treatment pre and post chemotherapy.
Dr. Ruman obtained her Bachelors of Science in Biology from Duke University and her medical degree at the University of North Carolina in Chapel Hill Dr. Ruman completed her residency training in Obstetrics and Gynecology at Long Island Jewish Medical Center. Dr. Ruman was selected to a three-year Fellowship in Reproductive Endocrinology and Infertility at New York Presbyterian Hospital-Columbia University, where she authored and co-authored several publications concerning egg donation and fertility treatment. Formerly a clinical professor in the Department of Obstetrics and Gynecology within the Mount Sinai School of Medicine, she also partnered with Reproductive Medicine Associates of New York (RMA of New York) to provide state-of-the-art fertility services and advanced reproductive procedures to patients in the greater metropolitan area. Dr. Ruman practiced for several years in Long Island prior to joining the team at RMA of New York and Mount Sinai.