Fertility Preservation and Breast Cancer

Studies have shown that fertility preservation is often an important issue for reproductive age women diagnosed with cancer.  A review article contains the following useful passage:

“The high success rate of ART should now be an integral part of the discussion about fertility preservation with women who are undergoing chemotherapy. Recent reports have suggested that fecundity with ART may be similar to natural fecundity in non-cancer patients, and an estimated 15 out of 1,000 live births involve ART. Until recently, a major hurdle in embryo cryopreservation in women with ER-positive breast cancer has been the concern over artificially creating high estrogen levels during ovarian stimulation. Furthermore, perceived time and cost constraints and low estimated success rates in ART have further limited the referral for consideration of ART in breast cancer patients.

However, recent studies have suggested that ovarian stimulation can be safely accomplished with aromatase inhibitors or tamoxifen, preventing high estradiol peaks during ovarian stimulation.[35] Using high doses of tamoxifen (60 mg/d) or letrozole (5 mg/d) with low-dose follicle-stimulating hormone resulted in sufficient numbers of mature oocytes to warrant harvest, fertilization, and embryo cryopreservation. The successful harvest of oocytes can be accomplished within one menstrual cycle and is feasible prior to initiation of chemotherapy. However, embryo cryopreservation requires that the patient have a partner at the time of harvest, or donor sperm are used. Recent advances in ART, however, now also allow the cryopreservation of oocytes not requiring a partner at the time of oocyte harvest and freezing. While the success rates of delayed in vitro fertilization (IVF) with frozen oocytes are lower compared with IVF with unfrozen oocytes,[36] this method still offers women without a partner at the time of diagnosis an option for a later pregnancy with IVF.

The initiation of ovarian stimulation and oocyte harvesting typically requires one or more menstrual cycles, therefore referral to the fertility clinic should occur as early as possible in the patient’s cycle. In most patients, chemotherapy does not start until 2 to 12 weeks after surgery. A referral to the fertility specialist and a possible intervention should be feasible. We have found that most hurdles are vastly reduced when an interdisciplinary collaboration is already in place.”

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