Artificial pregnancy after hormonal dependant Ca.

Rosa_Aurora184161 · September 2013

Good morning ladies!

I'd appreciate to hear your experiencies and opinions.

I'd like to know if it's not indicated artificial pregnancy after a hormonal dependant breast Ca. or if it's not scientifically proven.

I'd like to hear the opinion and experiences of women who have gone to the same situation.

After having had a bilateral breast Ca. oestrogen, progesterone positive (stage IIA, 1 lympth node involvement, 1,3cm,grade2;the other DCIS no lympth nodes involved), bilateral mastectomy, chemo dense regime of AC+Taxol, nearly finishing it, 43 years old.

Would it be contraindicated to become pregnant due to hormonodependant breast Ca. by in vitro fertilization / artificial insemination? I think it would neccerary to have the ovaries stimulated by inyecting oestrogens. Would it be risky for the homonodepedent Ca. to grow or spread?

Oncologist says to take Tamoxifen for 5-10 years after chemo, so no pregnancy, can the treatment be posponed?

Any ideas, any experiencies?

Thank you very much in advance.

peggy_j · September 2013

These are valid questions and good ones to discuss with your MO.

I suspect your thinking is right--giving extra hormones to someone with a history of BC would increase her risk for recurrence, including distant recurrence (mets) since a lymph node was involved. Tamox works as a selective estrogen "blocker," so taking extra estrogen would do the opposite. I believe a woman's body also increases its estrogen during pregnancy, too. Some women stop having their periods due to chemo. Since your whole body is impacted during chemo, there's also the question of how long to wait to allow your body to recover from chemo before even considering another significant whole-body "event," like pregnancy. Sorry I don't have better news. I know this isn't the same, but I know several people who adopted in their 40s (including people who had children the "natural" way and later adopted) and they seem very happy. Sending you good thoughts.

Rosa_Aurora184161 · September 2013

Well oncologist was more worried about not having Tamoxifen por a period of time (during pregnancy) than for estimulating the ovaries. The idea was to frozen ovules now and keep them and then in about 3-4 years to interrup taking Tamoxifen, get pregnant and after that to continue taking Tamoxifen. But no idea if this can be done or if it's too risky anyway. Has anyone got any experience of this sort? Thank you very much.

RebzAmy · September 2013

I know this is a very sensitive subject and I wanted to post to you so that you have food for thought . I'm no specialist or anything just an ordinary person (well maybe not so ordinary ) but a girl I went to school with recently passed away from breast cancer that had spread. From what I understand, she was diagnosed at around 28 years old and was on drugs to stop the hormones for 5 years. She got married, wanted to have a baby so went through IVF treatment (due to chemo drugs affecting her fertility), when the baby was born, the girl wasn't well and following scans and investigations it was discovered she'd developed secondaries. They think it was due to the IVF treatment as her breast cancer was the hormonal type. This is very sad and she herself said that she doesn't regret going through the IVF treatment - she was a very brave girl. I personally had HER2+ breast cancer but if I had hormonal positive breast cancer, I would definitely not get pregnant, I'd probaby try and adopt.

Rosa_Aurora184161 · September 2013

Hi RebzAmy:

Thank you for your reply . I'm sorry for your friend .

I don't think IVF treatment produces malformations or secondaries in future babies. Actually they do certain genetic tests before implanting the embrio in the mother to check everything is O.K.

Also, chemo can affect your fetility in the sense that can stop your ovulation and can create infertily but not in the sense that the ovules have something wrong in them, you just ca nget into menopause.

It's true that during chemo or when taking Tamoxifen you cannot be pregnant because this can cause malformation and certain deseases in the feto and future baby. But afterwards, after finishing or interrupting treatments there is no problem at all. Another thing is the age of the ovules/of the patient, when older there are more problems with the quality of the ovules and more possibilities of having a baby with down syndrome, for example.

I still would like to hear any woman experience on this topic. Thanks you very much.

RebzAmy · September 2013

Rosa-Auroa - just to clarify, the baby was and is fine (there was nothing wrong with him) it is the mother who got secondaries from going through the IVF hormonal treatment and managed to survive on treatment (hormonal drugs and chemo) for 4 years and she passed away last week.

Rosa_Aurora184161 · September 2013

RebzAmy Thank you. Sorry again to hear about your friend lost. It's very sad.

I wonder what stage was her cancer, how many lymthpatic nodes were involved, the grade and size of tumor, if she was also Her2+ or not. Kind of treatment she got (lumpectomy vs mastectomy, radiotherapy, chemo,Tamoxifeno,..) All these factors depend on recidivias and survival.

How long did your friend take Tamoxifen? Now oncologists are indicating to take it for 10 years!

Oncologist is more worried about the time being without Tamoxifen (during pregnancy, I guess) than the pregnancy as such. IVF procidure to extract ovules can be done with other meds not so high with oestrogens, said oncologist. It's not proved that being pregnant after having had a hormonal dependant Ca. would affect you in some way to provoque recidivas, but it might be worrying being unprotected without Tamoxifen while being pregnant. That's why I think I'd have to wait to almost finishing with Tamoxifen, at least 4-5 years to get pregnant.

But no idea if it would be risky anyway.,....

RebzAmy · September 2013

Yes it's very sad. She wasn't HER2+ only hormonal positive and was okay from the age of 28 until she was 37 when she had her IVF treatment. She was told that it was probably due to the IVF treatment. If you think about the fact that if your breast cancer is hormone positive, you are given drugs to prevent the hormones being produced, then it makes sense not to get pregnant or go through treatment for breast cancer because you are simply flooding your body with all the hormones that were causing your cancer to feed.

rozem · September 2013

Rosa - (sorry i didnt copy and paste this correctly) take a look at this thread:

Forum: Young with Breast Cancer Topic: Coming off tamoxifen early to have a baby

I know from talking to other women in your situation (2 friends) that there is no consensus in the medical community if it is ok to get pregnant after a BC diagnosis - but i know that both their doctors wanted them to finish their 5 yrs on tamox. Hope this helps

Rosa_Aurora184161 · September 2013

Still wondering if it's safe to interrupt Tamoxifen to get pregnant. Having a hormonal dependent breast Ca., grade2, 1 lympth node involved, premenopausic.

Oncologist is very conservative and prefer not to stop Tamoxifen for 10 years, due to an international study, ATLAS, which concluded that taking Tamoxifen for 10 years was better than for 5 years in preventing Ca. recurrences.But after 10 years it'd be too late to be pregnant.

Oncologist is worried about not being protected by Tamoxifen during pregnancy (9 months-1 year) than for being pregnant.

Was/is anyone in the same situation? What did you do? or What are you going to do? What is/was your oncologist opinion? Thanks.

oneday · October 2013

Hi Rosa_Aurora,

I have just finished 2 rounds of ivf to freeze embryos and I am due to start chemotherapy this week. It meant delaying my chemo for 6 weeks while I took ivf stimulation drugs and underwent 2 egg collections. I don't think that anyone really knows the risks of stimulating the ovaries to produce high estrogen during ivf egg collection. Some oncologist would probably say that the drugs are taken for such a short period of time (10 days per egg collection in my case). I suppose the main issue is that, depending on how long it takes you to get through surgery, you may need to delay your chemo to freeze eggs. Chemo is most effective if started within 6 weeks, if not, within 12 weeks, and most studies on the effectiveness of chemo are based on those times.

Keep in mind that embryo freezing is the only non-experimental method of fertility preservation. Your other options are zoladex shots to put your ovaries into hibernation during chemo in an attempt to avoid damage. Some studies showed a benefit of zoladex working, but some did not. As for ovarian tissue freezing, a handful of births worldwide, so very experimental and the younger the patient the better.

The other option, is to do nothing. Generally, the younger you are at chemotherapy, the less likely you are to sustain overwhelming damage to your ovaries. But if you are taking cyclophosphamide (TC, AC, TAC etc), you will sustain damage as this is the worst substance for fertility. This is a very personal thing, and depends not only on age of patient, type of chemo, dose, duration etc, but your own personal fertility and the way your body decides to react to chemo. Some studies show 28 year olds going into menopause, others show cases of 38 year olds retaining enough ovarian function to have a subsequent preganancy a few years later. Keep in mind also, that chemo is likely to cause premature menopause, so if you do retain the ability to get pregnant and have children, it will be for a limited time, your fertility will most likely not extend until the average natual age of 43 or so, and you would most likley be menopausal before the average time of 51 years.

Other options such as egg or embryo donation are possible, and as everyone has pointed out, adoption. (Forgot to metion that egg freezing is an option with low success rate, if you do not have a male partner or sperm donor). However, again, age is a factor. I'm not sure how old you are but, women 35 or older are on average not likely to produce a large number of eggs to freeze and the process of freeze and thaw tends to wittle away the numbers significantly, then there's fertilization, growth into embryo, transfer, pregnancy and live birth. Even something like 8 frozen eggs would not guarantee a baby.

As for coming off tamoxifen after a certain time to be negotiated between you and your oncologist (generally after 2 years or more of tamoxifen), women do that all the time. It depends on your oncologist and your situation.

As for pregnancy, it's a really hard one. All I can say is that none of the studies has shown a decreased disease free survival rate for women who have a pregnancy after treatment for breast cancer, compared to matched controls who did not have a pregnancy after treatment for breast cancer. Pregnancy or not, the same recurrence rate exists, so when people do have pregnancies and recur, it's hard to say that the recurrence was a result of the pregnancy.

As for ivf stims, it is of course possible that the estrogen spike may put some women into recurrence, but again, that depends on so many factors. I'd imagine that includes the tumor burden already existing in the woman's system when she stopped tamoxifen and started stims. It's so devastating to hear about young women who just want to live a normal life and experience motherhood, but who recur and die before getting a chance to do so. RebzAmy's friend, may she rest peace.

Ask your oncologist for advice on your fertility options, maybe for a referral to a fertiliy specialist if your oncologist does not want to advise you. Of course, your oncologist needs to assess your fertility preservation preferences, as your options do depend on your life situation, age and the characteristics your tumor.

Rosa_Aurora184161 · October 2013

oneday Many thanks for having taken your time to reply. I really apreciate it. Best wishes to you!

Rosa_Aurora184161 · April 2014

These days are being very hard. After having a long chat with oncologist and ginecologist specialised in reproduction they both decided it's too risky to be pregnant any moment in my life (by embryos donation and hormonal uterus preparation for pregnancy ) due to the hormonal implications of the process, that is, more than 9 months without taking Tamoxifen treatment; 9 months of pregnancy fueled with natural estrogens in the body. Having a high hormonal dependent invasive breast cancer (ER+) it's highly recommended not to get pregnant ever but the opposite procedure, that is, to take Tamoxifen to reduce the level of estrogens in the body for 10 years! What about you? Were you advised the same? Thanks.

oneday · April 2014

Rose_Aurora,

My oncologist is willing for me to have a pregnancy with my frozen embryos and then go back on tamoxifen to complete the 10 years. She seems to have strong faith in clinical trials and studies. As you know, the studies have not shown an increased rate of metastasis for women who had a pregnancy after treatment. The longest study follow up period I've seen is 15 years. Not sure whether the women who had a pregnancy completed full treatment (5 years of tamoxifen or not) prior.

For so many years women were advised to not get pregnant due to the hormones, but no study has ever shown increased recurrence rate for women who did. It's really hard to know what to believe.

My oncologist has said no more hormones for me though, as I was thinking of trying to find a gestational surrogate to carry the pregnancy (someone younger who has not done chemo) and then trying to stimulate breastfeeding myself and breastfeeding the baby for six months. My oncologist said only if stimulating milk can be done without hormones. I breastfed my first for over 4 years, and apparently milk supply can be stimulated without hormones. Hard to believe. I'm thinking the best thing for everyone concerned would be finding a surrogate and going off tamoxifen only long enough for breastfeeding for a short while.

I wouldn't want to be off tamoxifen for 18 months.

I'm still working out what I'm going to do. I already have one child, but I was just starting to attempt to get pregnant again when I was diagnosed, and I'm finding it hard to let go of that.

I have read everything I could find about recurrence risk and pregnancy, and I've been in deep thought about my cancer and the way I wish to live my life. I personally believe that a pregnancy would not increase my risk of recurrence. I'm more concerned about what affect my age (42) and having done chemo would have on a developing baby, whether I could have an uncomplicated pregnancy and my energy levels for looking after the baby if I did the pregnancy.

Have you thought about surrogacy at all?

Srh242 · October 2014

surrogacy is expensive

oneday · October 2014

Hi Srh242,

Yes. Sorry, I should have said altruistic surrogacy. (Commercial surrogacy is illegal in Australia, so we tend to take 'surrogacy' to mean altruistic surrogacy and use the terms 'commercial surrogacy' or 'overseas surrogacy'.)

The least expensive option would be altruistic surrogacy where a close friend or family member carried your embryos, and you could probably avoid paying for legal contracts and counselling.

Srh242 · October 2014

yes!

Artificial pregnancy after hormonal dependant Ca.

Comments

Categories