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Success with Fertility Preservation after Cancer Treatment
by Leigh Ann Woodruff, May 30, 2012
After a cancer diagnosis, treating the disease often poses a threat to a man or woman's fertility. As treatments for cancer have advanced, so have methods to preserve fertility, and now women can freeze their eggs, men can freeze their sperm, and couples can freeze their embryos prior to undergoing potentially lifesaving treatments. And while high profile couples such as celebrities Giuliana and Bill Rancic are bringing more attention to the subject after Giuliana's breast cancer battle and subsequent pregnancy via surrogate with one of their frozen embryos, it is important to continue spreading the message among people newly diagnosed with cancer.
Interestingly, a recent British study published in BJOG: An International Journal of Obstetrics and Gynaecology found that there are significant gaps in the fertility advice women receive following a cancer diagnosis when they are compared to men. While men were actively encouraged to consider storage of sperm, few women could remember fertility preservation being discussed. A Swedish study, also published recently in the Journal of Clinical Oncology found that of nearly 500 cancer survivors ages 18 to 45, 80 percent of the men said their doctor had told them their chemotherapy could affect their future fertility, while only 48 percent of women said the same thing.
"For women that are out there that are undergoing cancer treatment, their oncologist needs to be leading the way and educating them about what is the potential of them going sterile — and not only from chemotherapy but surgery, radiation," says Germaine Malagise, an eight-year cancer survivor who had had two children from frozen embryos. "I did do a lot of research on my own as to who has the best record with in vitro fertilization. Be knowledgeable and try to get the answers either through your doctor, through the internet, whatever it is."
As a nurse practitioner in the University of Pittsburgh Cancer Center, Germaine was more knowledgeable than most about cancer and fertility. The 43-year-old married her husband at age 30, and they immediately began trying to conceive and soon went down the infertility path. They tried Clomid and had a miscarriage. Then they tried intrauterine insemination (IUI), and were just about to embark on in vitro fertilization after an evaluation at the Cleveland Clinic in May of 2004 when Germaine found a lump in her breast that changed everything.
The diagnosis was Stage 1 infiltrating ductal carcinoma. "I was 35 years old when found the lump," Germaine says. "I went on for breast cancer surgery (lumpectomy) in August of 2004. And then I knew I needed chemotherapy, so we literally had about six weeks to undergo IVF and collect eggs and fertilize through the embryo stage and do cryopreservation, so that was September of 2004. It all happened very fast, and then I went directly into chemotherapy."
In addition, the tumor was hormone receptor positive, which means it depends on the presence of estrogen and progesterone to spread. "The process when you undergo in vitro is you have to take hormones to begin with, so I had to take estrogen in the setting of knowing that my cancer was estrogen positive. That was a little scary, but we did it," Germaine says. The embryo retrieval and fertilization were a success, and the couple had 10 embryos to freeze.
Germaine had four rounds of chemotherapy from September through November of 2004, then radiation, and then she had to go on tamoxifen for five years. "You take tamoxifen to basically block estrogen production," Germaine says. "And when you're on that, you can't get pregnant."
It wasn't until June of 2009 — five years later — that Germaine had the first embryos transferred at the Cleveland Clinic in the hopes of getting pregnant. "We had three embryos implanted and one took," she says. "We had four defrosted, and three were viable. My daughter was born in March 2010."
After eight months, they were ready to try again. "in December of 2010, we had the second go-round of embryos transferred," Germaine says. "They defrosted four, and only three were viable, and we had three implanted and one took. And we had our second daughter in August of 2011."
Take Time to Consider Options
Embryo freezing is generally the most successful option for cancer patients; however, this is usually an options that couples would consider vs. a single man or woman. "There is a much higher success rate for pregnancies and live births from frozen embryos," Jeffrey Goldberg, M.D., Section Head of Obstetrics and Gynecology at Cleveland Clinic. "Pregnancy rates are improving for frozen eggs, and more women in their 20s and 30s are now taking the opportunity to bank eggs."
Once a cancer diagnosis is made, things tend to move very quickly, and a patient may not hear or understand everything. A study published in the journal Cancer found that just receiving specialized counseling about reproductive loss and pursuing fertility preservation is associated with less regret and greater quality of life for survivors,
"After getting a devastating diagnosis of cancer, there often is a limited window of time for freezing eggs or embryos before a patient starts therapy. It’s a difficult decision to make at a very stressful time," says Dr. Goldberg. "The most important thing is that women, and men, be made aware that they have options — whether it’s freezing eggs, embryos or sperm."
Successful live births for cancer patients who have chosen fertility preservation is always gratifying, Dr. Goldberg says. "It's a thrill for our medical team when any of our patients have success."