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Dr Madhupriya
The extent of breast cancer in India has been steadily increasing for a very long time. Statistics show that fertility problems in this group have also increased due to drastic changes in lifestyle, lack of future awareness of fertility, and delayed marriage. Breast cancer awareness has spread to all age groups and hence they have a chance of early detection. But our society needs to be made aware of fertility issues related to cancer treatments and available fertility preservation treatments.
Before going ahead with cancer treatment, the patient should be made aware of the possible impacts of cancer treatment. This can lead to inability to conceive a child in the future and negative reproductive outcomes such as poor quality and quality of post-egg cancer treatments, ovarian failure, premature ovarian aging, inability to procure their own biological child.
How do we typically identify fertility issues in women?
When a woman is unable to bear a child after repeated attempts (usually after trying for a year), they are called subfertile. Fertility problems can usually occur when reproductive hormone levels are abnormally low or high or if gamete-producing organs are removed or not functioning properly. Problems in the uterus, tubes and ovaries can also trigger infertility. Scarcity of healthy eggs, sex hormone disturbances, blocked fallopian tubes caused by pelvic inflammatory disease, polycystic ovary syndrome (PCOS / PCOS), uterine fibroids, endometriosis, primary ovarian failure (POI) and cancer treatments are among many other conditions.
Effects of cancer on female fertility
Chemotherapy works by destroying cells in the body that are dividing at an unusually fast rate. In many cases, the possibility of cancer drugs / surgery / radiation therapy causing more damage to female tissues and organs than cancer itself is very high. Radiation could interfere with the reproductive system and lead to sub-fertility or infertility (sterility), that is, difficulty conceiving a child naturally, in most cases permanently.
Oocytes (eggs) tend to divide quickly and are often destroyed by chemotherapy which ultimately affects fertility. The variety of oncologic surgeries, chemotherapy drugs and radiation used for cancer treatment can have different effects, and the proportional risk of infertility therefore varies. Common risk factors are:
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The patient’s age and stage of reproduction; for example, before or after puberty / menopause, etc.
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The type of treatment given (radiotherapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, stem cell transplant)
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The dose and frequency of treatment
There are a variety of drugs associated with the risk of infertility – cisplatin, busulfan, carboplatin, doxorubicin, lomustine to name a few. In addition to the drug, if radiation therapy is given near the pelvic area, the risk of infertility (permanent damage to egg production) increases.
Savita, a 33-year-old single woman, was diagnosed with a breast lump during her annual checkup. Upon further investigation, it turned out that she had breast cancer which required immediate medical attention. Before starting her cancer treatment, she was counseled on the benefits of preserving fertility. As a result, she underwent fertility treatment and managed to store 18 mature oocytes. Now, once she gets over this disease and gets clearance from her oncologist, Savita can undergo ICSI (IVF) with her future partner’s sperm and form embryos from her own eggs and undergo a transfer. embryos to reproduce its own biological child.
Women should be informed of all the fertility risks associated with cancer and the cancer procedures and fertility treatment options that are available to suit them. Her cancer care team should provide a detailed plan of her fertility options before or while planning her cancer treatment.
Women undergoing cancer treatment should be made aware of the impact of cancer treatment on reproduction and that it can be extremely harmful to the fetus if conceived during cancer treatment, which can result in a miscarriage. The logical step would be to preserve fertility, even if the woman awaiting cancer treatment is currently not sure whether she wants to have children in the future.
Preservation of fertility in patients with breast cancer
Here are some recommendations for preserving the fertility of breast cancer patients that would not hinder their journey to become a biological mother.
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Cryopreservation of embryos
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Freezing oocytes (unfertilized eggs): Women can freeze mature unfertilized eggs. This procedure is similar to freezing embryos, but the eggs are frozen without being fertilized by the sperm. This is an option for young single women / women without a male partner currently.
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Preservation of ovarian tissue: Here, ovarian tissue is surgically removed and frozen. The surgeon can transplant the tissue after cancer treatment. This might be the only option for girls who cannot undertake egg or embryo freezing, as some girls might lack time or sexual maturity. But unfortunately, this is an experimental process and not a standard option.
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Radiation protection that protects the ovaries: There is a chance that women will receive less radiation, which preserves fertility.
Treating cancer is an extremely trying process. Patients have a lot of difficult decisions for themselves. The risk of infertility which might arise unexpectedly in the future only adds more pressure and stress on the patient which can be cause for concern. It is the job of the combined cancer care team and the fertility team to lead the way and come up with viable options. Here it must be reiterated (after considering all possible options) that freezing embryos / oocytes is the easiest and most effective way to enjoy biological motherhood even after undergoing treatment for breast cancer.
It is high time that reproductive women with breast cancer were made aware of these fertility preservation options so that they could embark on their journey to first become cancer free and then become a mother without any mental limitations. The patient should be informed of all the options available to her. This process can be overwhelming, but we fertility experts will be there every step of the way on your oncofertility journey to help you along your journey to parenthood.
(The author is a fertility consultant, Vadapalani and MRC Nagar, Nova IVF Fertility Chennai)
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