Fertility Preservation Help

Cucho

Hello!

I am confused as to the safety of using fertility preservation methods in the case of my ER+ breast cancer prior to chemo.

What I am referring to specifically is the procedure involving the 2 weeks of estrogen injections prior to egg harvesting. It seems there are no signficant medium or long term studies on increased recurrance in women who do this procedure, although theoretically it is very suspect, (even with a modified protocol using Letrozole..) 

My MO and surgeon were both very against this procedure in the case of my ER+ bc. But I have heard of some alternate viewpoints and even success stories. I am having a hard time just saying "oh well too bad" regarding loss of fertility. I am 33 and not confident that after chemo and 5 years of tmxfn I would have much of a "natural" chance of conceiving. 

I am curious as to what people have researched or heard on Fertility Preservation. Has anyone out there who is ER+ done egg harvesting? Has anyone thought about it and decided against it? 

Thanks

nancyh

Cucho,

First of all, warm welcome and big hugs to you.  Lots of big, complicated questions you are dealing with.  I was in a similar boat with you when I was first diagnosed and totally get what you're going through.   I'll send you a PM,

NancyH 

Moderators

Cucho, as well as the personal experiences and insights you'll receive from other Community members, there is an extensive section on Fertility and Pregnancy Issues During and After Breast Cancer at the main Breastcancer.org site.

Welcome to BCO

Judith and the Mods

sweetbean

I totally did it.  They put me on Femara during the fertility treatments to prevent the hormones from feeding the cancer.   then I did chemo, surgery, and radiation.  I am fine and now I have 7 eggs in storage.   Have you had surgery yet?  

petagae

I went to see a Fertility doctor who specifies in cancer patients; he also works with my ONC and Surgeon. The ONC had no problem with the injections and becuase of my age (27) the fertility doc said it would only be 6-9 days of the injections before harvesting so it would not cause a substantial raise in my hormones. I started the process (all the tests and starting BC so they can control when I ovulate), but then decided that I didn't want to put myself or my body through the addtional stress. I also did research and didn't like the numbers for the use of the frozen eggs.

MiniMacsMom

I decided against it and here is why.  I had my mx and had lymph involvement.  Before surgery, I only had a Mammogram an US to show the extent of my disease.  I was not confident that my surgeon had gotten all the cancer out, and i didn't want to risk activating any more cancer.  I was dx with 99% er positive stage 3 BC tumor a few months after I stopped nursing. I am convinced the high estrogen from my pregnancy fed my tumor, encouraging its growth.  without being 100% positive all tumor was gone, I didn't want to add more ER to my body.   I also had significant issue with the letrozol.  So thats what they give you to reduce the effects of ER on your tumor.  Do you know WHY premenopausal women don't get that compound.  Because it DOESN"T WORK in us.  If you read the research articles on it or a comparison of it to tamoxifen, the LEtz only works locally at reducing estrogen in the areas of the ovaries.  It doesn't work as systemically as the tamoxifen.  This info all helped me to decide NOT to harvest eggs.  I researched it independently of any advice from my MO and the reproductive endocrinologist.  Both of my MOs were happy with my decision.  In respect to my instinct not to do it, I found out after my Pet scan (which you cant get within the same month you are harvesting hte eggs for fear of damaging them) that I had residual tumor in sub pectoral lymph nodes that the ER could have encouraged the growth of. 

Another option you can consider, which was recommended by my BF godfather a highly ranked Reproductives specialist was ovary preservation.  This is where a piece of your healthy ovary is stored and then put back after chemo and surgery.  This is an experimental treatment but it shows much promise and is much safer than the ER spikes.  He was not at all supportive of egg harvesting. Though I am totally blessed and content with my one child, I still have twinges for another from time to time, but I don't regret my decision not to harvest my eggs. 

Just my 2 cents.  Pm me if its confusing, I have rlly bad chemo brain   Not nearly as articulate as i used to be

Angelfalls

Cucho,

It's such a difficult call and such a personal choice. The only thing I can do is tell you my story in the hope it'll help you with your own decision.

I was 31 when diagnosed, had just got engaged and had no kids. I wanted to throw everything at the BC and didn't give fertility a second thought. My periods returned shortly after the end of chemo and so, in the back of my mind, I thought I'd finish the Tamox, then start trying for a baby. But at 35, I got a recurrence and my onc spoke to me about ovarian suppression as a mainstay of my tx. This time, I did have to think long and hard about fertility and my chance at motherhood. I did some research and was heading down the route of freezing eggs/embryos until a conversation with my onc when he told me that there were no guarantees I would be around to care for any possible child and that lots of research points to pregnancy increasing the risk for ER+ BC, let alone harvesting procedures (though he did also say that there is considerable research which shows the opposite!). As stepmother to a daughter who lost her mum to cancer when she was 12, I could not in all conscience risk putting another child through that. So I went ahead with my tx and had my ovaries removed. No kids for me. It was a really tough decision, but it was the right one for my circumstances which I know were very different from yours. I've since had another recurrence, btw.

I hope that whatever you choose to do, you will come to an informed decision that is the right one for you. Take care, Angelfalls xx

Cucho

Thanks everyone so much for their replies I am still thinking to go ahead with it for purely psychological reasons, as the logical response seems not to be do it. those of you who did not. Still, Im not 100 percent, especially cuz I dont have an ONC who can support me in this decision.

I would have loved to be able to make a real informed decision- the lack signficant research on the issue surprised me. It was explained to me by the head of the fertility clinic that freezing is a very new proceedure for women with cancer and sadly, no one seems to be focusing on researching the safety of this proceedure on young women with ER+ breast cancer. Plus I dont think clinics are monitoring us women who chose to do it. Seems this is because there are not enough young women with bc to make it a serious topic of research. Seems unacceptable considering the billions of money raised for breast cancer research- how much of this is used for researching the unique needs of special populations young women...?.

sakura73

I was 99% ER+ and I did a cycle of egg harvesting before chemo. My onco was fine with it, the fertility doctor gave me reduced doses of the drugs and also gave me Tamoxifen for the 2 weeks of injections to minimise risk. It is only a couple of weeks, and if you are about to do chemo then the risk if any of the estrogen will be more than counterbalanced by the complete estrogen vacuum you will be during chemo. I thik it is important not to get too overwrought about estrogen. It is only the enemy if you have too much of it. In proper amounts it is a necessary hormone for women.

The egg harvesting did not really work, though, I suspect because of the stress and the reduced drug levels. I also had part of an ovary removed and frozen as additional fertility preservation. And I had injections of Zoladex during chemo to shut everything down to try and protect my ovaries from damage from chemo.

Can I say that, given your profile as stated in your signature, if you are doing chemo I really urge you to look at the stats on whether 5 years of Tamoxifen will do you enough good to justify it. I was 36 when chemo ended, and decided that the additional benefit of 5 years of Tamoxifen were not big enough for me (18% risk of recurrence after chemo, reduced to 12% if I did 5 years of Tamox, so still leaving me with 12% risk plus effectively removing my hopes of having a baby. Get your onco to spell out the real (as opposed to relative) benefit of Tamox before you take it. Everyone's numbers are different. 

 I decided not to take Tamoxifen, and to try for a baby naturally if my fertility returned. It did. Chemo ended September 2009, period returned February 2010. Conceived in November 2010 and my beautiful baby Arthur was born in August 2011.  I have 3 eggs and part of an ovary in the freezer and I am glad I have them, but in the end I didn't need them. Zoladex and good fortune meant my fertility was not permanently damaged by chemo.

I wish you all the best, please PM me if you would like more info.

Rachel x

SKD

I also did the fertility treatments. It as nice to have for piece or mind in case my periods did not come back but it is very expensive. I was never educated before on whether it would affect my cancer. But when I went back and asked them, they said they were giving me those hormones for a short amount or time so it was safe. However, it totally depends on your own situation and what your doctor thinks is best with your condition. I was lucky and my periods did return but we still don't know if we can have a healthy pregnancy yet.

Pgjoh

To all ladies considering fertility preservation under 40



I just went through embryo cryopreservation at the pacific centre for fertility in Vancouver. they provide this service free to women under 40 who have breast cancer and will possibly go into menopause with chemo or other hormonal treatments. if your family income is u der 100,000 per year and charge 50 percent if above. I ended up paying about 800 dollars for medicine and sperm analysis which for us was ok. I thought this should be known for Canadian women if cost was Abigail barrier in the decision, plus they get you in ASAP. I'm starting chemo tomorrow with 7 embryos I. The freezer. Will I use them I don't know, but cancer is not going to take everything away from me.



Amy

IllinoisNative

Do they pay for the implantation afterward the treatment?  Although I'm not Canadian.  I don't know if that makes a difference...lol.

I have two embryos that I created before my treatment. They harvested ten eggs, but because of my age at the time (36), only two took.  So once I'm done with my two years of Tamox, I'm having them implanted.

Cucho

Hi Illinois, your story is interesting, I wish you all the best with the implantation! I would love to hear how it goes for you. I also was able to freeze only two embryos. Also, I note from your signature that you are BRCA2 positive, I am BRCA1 positive. Did you think about testing the embyros? Im not sure if I would..

IllinoisNative

I did the fertility treatment before I found out I was BRAC2  positive.  I may have still done it had I known beforehand...I don't know.  As for testing the embryos, I don't know.  They both have to be implanted at one time so I have one shot.  I suppose I can try to get pregnant on my own but I'll be near 40.  It will be harder.

MiniMacsMom

We decided against fert preservation and if... a big if we decide to have another bb based on new.research we would prolly use ivf just so i dont pass.this brca 2 gene on. I get lil bits of anxiety looking at my son and thinking he might carry the gene and have to go through this. If there is something i can do to spare my bbs i will. But thats my choice. I have a friend who carries.the gene for hemophilia and they have choosen to not do ivf to irradicate the gene and every pregnancy is stressful. Its a hard choice good luck!

Cucho

I found out my BRCA1 status a few days before I was to start the IVF cycle. It was such a huge decision to make to do IVF considering my positive ER and HER2 status, so that once that decision was made, it was all forces ahead. 

I have heard from 2 MOs that BRCA1 in particular is linked to lower embryo outcomes in IVF and lower fertility overall. That freaks me out, talk about natural selection.

It takes determination and courage to do IVF in light of a breast cancer diagnosis. The decision, the process, the procedure and the result was all very challenging and you need to be prepared for yet another emotional rollercoaster, in addition to your breast cancer. You need also to be prepared to fight a little harder than you already are, and take some additional risks, all so that your true dreams may come true.