5 secrets of fertility preservation in breast cancer patients

Dr. Anshu Jindal (MD, DNB, MNAMS) IVF Specialist & Clinical Director Jindal Hospital, Meerut in Conversation with Dr. Tanya Bukshee Rohatgi MD DNB MNAMS FICOG, MRCOG (London, UK) DFFP (London, UK) Director The Womens Clinic Principal Consultant IVF, Reproductive Medicine, Surgery and Onco-Fertility Max Super Specialty Hospitals, Delhi & NCR
5 secrets of fertility preservation in breast cancer patients.
Secret-1 Breast cancer is the commonest cancer in women of reproductive age group. Cancer can affect fertility. The fertility depends on various factors like, the age, the ovarian reserves, the type of cancer and the chemotherapy protocol planned.
Platinum based compounds and alkylation agents like cyclophosphamide are highly gonadotoxic. In young patients Less than 30 years of age with multiple cycles of chemotherapy, the risk of amenorrhea is 20% compared to 80% in women more than 40 years of age.
Secret-2 Embryo / oocyte freezing is the standard care available after two- three weeks of ovarian stimulation followed by oocyte pick up. In hormone sensitive tumors aromatase inhibitors like Letrozole or SERM’S like Tamoxifen can be used.
A mild stimulation antagonist protocol, with agonist trigger is usually used to minimize the Estradiol levels and to avoid hyper stimulation
Dual stimulation can also be used to increase the yield of oocytes and hence the number of oocytes / embryo’s available for cryopreservation. For BRCA carrier patients, pre implantation genetic diagnosis is offered with IVF.
For young patients who cannot wait we have the option of ovarian tissue cryopreservation wherein the ovary / or some ovarian tissue containing the primordial follicle is cryopreserved. It is then transferred back after the therapy is completed after doing various tests in order to avoid reseeding of cancer cells. The ovarian tissue is transplanted back into the peritoneal cavity or in the arm or the abdominal wall.
Secret-3 Temporary ovarian suppression by giving GnRH agonists like zoladex for at least one week prior to chemotherapy till the end of chemotherapy every month. This is specially done for triple negative young premenopausal patients.
Secret-4 Pregnancy should wait till the last recurrence or completion of hormonal therapy in conjunction with oncologist.
The pregnant patients are more prone to preterm labour and low birth weight, hence need to be carefully monitored.
Secret-5 A special group called BRCA carrier patients have a higher chances of hereditary breast & ovarian cancer. BRCA carrier should be offered pre-implantation genetic testing with IVF.
Fertility preservation in breast cancer patients is emerging as a promising multidisciplinary approach. In the future, creating artificial ovary in the laboratory or artificial gametes may give us an answer for the fertility preservation in these cancer survivors.
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As we are aware that digital medium has become a very powerful platform for disseminating knowledge in all fields including our own field of medicine. But sometimes when a doctor tries to access knowledge from the internet, they find themselves inundated by information yet find it hard to apply it in a particular clinical situation. In order to clear that confusion & help them in assimilating that knowledge we at “global art forum” are starting a web series on ‘5 secrets unravelled by our experts’ on various topics of obstetrics, gynaecology & infertility. And who could do it better than you with years of clinical experience.
We bring to you this video from the state of the art fertility centre for men and women, Jindal hospital and test tube baby centre. This video is for patient and doctor education so that you are wiser in pursuing your dream and goal of having a baby for yourself or your patients. All the best-You are a champion!