“ She was a true fighter, you could see it in her eyes.
She was not born strong, she was made strong.
She was sculpted to be her own hero when the world let her down
And she kept picking herself back up. “
Each word of this quote seems very true when I look at my patients who are “Cancer Survivors”.
One busy day in my clinic I saw a young woman around 25-26 yrs old, shabby look, with prominent IV marks on both forearms walking slowly in the room. She looked a bit apprehensive and worried. I tried to make her comfortable but nothing seemed to work. After a few minutes of fruitless discussion, she jumped into the question which was bothering her.
WHY NO ONE INFORMED ME ABOUT FERTILITY PRESERVATION?
I just kept on looking at her face. I had no answer for it. Immediately I understood all her concerns and grievances.
This young lady was diagnosed with Non-Hodgkin's lymphoma 5 years back, underwent chemotherapy sessions, and now left sterile. As of now, when she is thinking of marriage and family life we are not sure is it possible for her to conceive with her own eggs. This might be the story of a more young cancer survivor. With the advancement of technology and new treatment options, more and more people are living beyond cancer. The cancer survival has gone 86-90% in some cases. So this is the time to focus on unaddressed post-cancer issues. If she would have had one consultation with the fertility specialist, there might have been an option of egg preservation. This would have definitely made her more confident in starting the new chapter of life.
The fertility preservation(FP) topic is very close to my heart. There are multiple issues that are not even looked into. For a girl, a woman who is undergoing cancer treatment, we have multiple options to preserve her fertility potential. Yes of course after hearing a diagnosis first thing which anyone will think is to survive. Definitely giving priority to cancer treatment is the goal. But when we come to know all the effects and side effects of treatment, fertility is one of the major concerns.
Female Fertility Preservation
Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future.
People with certain diseases, disorders, and life events that affect fertility may benefit from fertility preservation. These include people who:
Are about to be treated for cancer.
Are about to be treated for an autoimmune disease, such as lupus, rheumatoid arthritis.
Are about to undergo transplant such as bone marrow transplant, renal, liver transplant.
Have a genetic disease that affects future fertility.
Delay having children.
What all can be done?
Egg (oocyte) cryopreservation
Ovarian tissue cryopreservation in cancer patients
When to do and how is the Procedure?
Our foremost priority is to start cancer treatment. In a scenario where surgery or chemotherapy is planned in 2 weeks, we can start the procedure right then and return to oncotreatment in 2 weeks. In breast cancer, patient cryopreservation is planned after surgery but before chemotherapy. During normal IVF we start injections on the second or third day of the menstrual cycle, but with new protocols specially designed for cancer patients, it can be done on any day of the cycle. Our major aim is to retrieve the maximum number of eggs.
The procedure consists of daily two or three fertility injections for 12-15 days to stimulate the maximum number of follicles. The egg resides within the follicle. Transvaginal ultrasonography is done every 3 or 4 days to see the growth of follicles. Once they are mature, retrieval is done through the vagina with the help of a needle and transvaginal ultrasound. The patient is anesthetized for a duration of around 15-30 minutes. There is no need for hospital admission generally. these eggs are cryopreserved with vitrification technique for an infinite period. In married females, fertilization can be done with the husband’s sperm to form an embryo and the embryo is stored.
The main concern here is does fertility injections fasten the course of cancer?
In Europe(Germany, Austria, Switzerland), Denmark, Italy, the United States of America, and other countries also, It is a common practice to store eggs and embryos and ovarian tissues. They have been practicing for 20 years. There is no evidence that these injections enhance the growth of cancer. In hormone receptive breast cancer patients use of tab letrozole which prevents estrogen formation showed no effect on cancer.
“FERIPROTEKT” and “ONCOFERILITY” are the two biggest registries in the world dealing comprehensively in the fertility preservation in cancer patients. Their data does not reveal any untoward effects on cancer. The complications related to a procedure like bleeding, infection, ovarian hyperstimulation syndrome are also minimal. OHSS also is now a day well controlled with advanced drugs.
Some of the FAQ I am answering, taking the example of breast cancer
Can I have a baby after having breast caner?
Some treatments for breast cancer might affect a woman’s fertility (ability to have a baby). For example, chemotherapy for breast cancer might damage the ovaries, which can sometimes cause immediate or delayed infertility. Still, many women are able to become pregnant after treatment. The best time to talk with your doctor about fertility is before starting breast cancer treatment.
Could pregnancy and breastfeeding make my breast cancer come back?
Many breast cancers are sensitive to estrogen, so there has been concern that for women who have had breast cancer, the high hormone levels that result from pregnancy might increase the chance of cancer coming back. Studies have shown, though, that pregnancy does not increase the risk of cancer coming back after successful treatment.
There’s also no proof that breastfeeding after breast cancer treatment increases the risk of recurrence. In fact, some research suggests having a history of breastfeeding might actually lower the risk of cancer coming back.
How long after breast cancer treatment should I wait before becoming pregnant?
If you want to have children, some doctors advise breast cancer survivors to wait at least 2 years after treatment is finished before trying to get pregnant. The best length of time to wait is not clear, but 2 years is thought to be enough time to find any early return of cancer, which could affect your decision to become pregnant.
For women with hormone receptor-positive breast cancer, adjuvant hormone therapy is typically recommended for 5 to 10 years after the initial treatment. Women who want to have children during this time are often advised to take hormone therapy for at least 2 years before stopping it and trying to become pregnant (and then starting it again after the baby is born).
Keep in mind that the advice about waiting 2 years is not based on data from any clinical trials. And some breast cancers can come back after the 2-year mark, so every case is different. Your decision should be based on many things, including your age, desire for more pregnancies, type of breast cancer, and the risk of cancer coming back early.
If I get pregnant, would my history of breast cancer put my baby at risk?
There is no proof that a woman’s past breast cancer has any direct effect on her baby. Researchers have found no increased rate of birth defects or other long-term health concerns in children born to women who have had breast cancer.
Could breast cancer treatment affect my unborn baby?
If you are still getting any type of treatment for breast cancer, including chemotherapy, hormone therapy, or targeted therapy, talk to your doctor before trying to become pregnant. These drugs could affect a growing fetus, so it is safer to wait until all treatment is complete before getting pregnant. It’s also important to remember that stopping treatment early can increase the risk of the cancer growing or coming back.
Can I breastfeed after breast cancer treatment?
If you have had breast surgery and/or radiation, you might have problems breastfeeding from the affected breast. Studies have shown reduced milk production in that breast as well as structural changes that can make breastfeeding painful, or make it harder for the baby to latch onto the breast. Still, many women are able to breastfeed.
If you are still taking any medicines to treat your breast cancer (such as hormone therapy), it’s very important to talk with your doctor before trying to breastfeed. Some drugs can enter the breast milk and might affect the baby.
Every man and woman with cancer or other diseases may not be eligible for fertility preservation. But having a single consultation makes a lot of difference in changing the outlook of patients towards their fertility potential. And one more thing that needs to be mentioned, it gives a ray of hope to cancer patients that they will survive this period and start a new life in the future. As I all talked about fertility preservation it's not a single issue. Sexual health issue which comes as a part of cancer treatment is always underlooked.
This will need a whole different blog to discuss. I will come up with this topic in the upcoming blogs. There are more topics lined up.
Any Queries and suggestions are always welcome.
Stay Safe and stay healthy
Dr. Archana Salve
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