after Cancer: Fertility, Pregnancy and Family Planning Sisters Network Inc. Annual National African American Breast Cancer 10 City Conference Tour Kickoff October, 2014 Terri L. Woodard, MD Assistant Professor Director of Reproductive Services Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center
33
Embed
Having Children after Cancer: Fertility, Pregnancy and Family Planning Sisters Network Inc. Annual National African American Breast Cancer 10 City Conference.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Having Children after Cancer:
Fertility, Pregnancy and Family Planning
Sisters Network Inc.Annual National African American Breast
Cancer 10 City Conference Tour Kickoff
October, 2014
Terri L. Woodard, MDAssistant Professor
Director of Reproductive ServicesDepartment of Gynecologic Oncology and Reproductive
MedicineThe University of Texas MD Anderson Cancer Center
Breast Cancer, Fertility and Family Building
• Approximately 6% of women diagnosed with breast cancer are of reproductive age (<40 years)
• Many will not have started/completed their childbearing plans
• Importance of addressing fertility and family building issues
The Truth about Fertility in Women
• We are born with all the eggs we are ever going to have
• Fertility declines with age
Impact of Breast Cancer Treatment on Fertility
• Depends on type of therapy
• Chemotherapy• Age
• The risk of amenorrhea after receiving typical adjuvant chemotherapy regimens in women under 40 is 21-71% versus 49-100% for those over 40.
• Must be considered in the context of age and your medical history
• Does not predict ability to become pregnant
• Just tells us how easy or difficult it might be
Is it “Safe” for Me to Become Pregnant?
• No guarantees about anything
• Must consider effects of treatment on other aspects of health
• Pregnancy in general is a stressful condition
• Consultation with a Maternal Fetal Medicine (MFM) Specialist• Preconception counseling• Management of medication• Management of coexisting medical conditions
Will Pregnancy Affect My Prognosis?
• Previously, pregnancy was thought to be contraindicated
• More recent data has been reassuring
Pregnancy after Breast Cancer
• Survivors who become pregnant do not appear to suffer worse outcomes than those who do not
• Meta-analyses• Azim et al
• 14 studies with 1244 cases and 18,145 controls• For overall survival, pooled relative risk was 0.59 (95% CI: 0.50-
0.70), favoring survivors with subsequent pregnancy
• Valachis et al• 9 studies• Pooled hazard ratio of death was 0.51 (95% CI: 0.42-0.62),
favoring survivors with subsequent pregnancy
• Similar findings for women with estrogen-receptor positive tumors
• Limitations of the data
Can My Future Children Be Affected?
• No increased risk of birth defects
• No increased risk of vertical transmission• Exception: Genetic syndrome: Pre-
implantation Genetic Diagnosis (PGD)
• Higher risk for cesarean section, pre-term delivery, low birth weight infants and delivery complications
When Should I Try to Conceive?
• It depends… requires thoughtful discussion with you and your health care providers• Usually recommended once you are out
of window of early relapse/recurrence• Must have period of adequate
treatment washout
Building Your Family
• Sometimes requires you to reshape the way you thought about building your family
• Range of options• Natural intercourse• Ovulation induction +/- intrauterine insemination• Assisted Reproductive Technology (ART)
• Oocyte cryopreservation (“egg freezing”)• In vitro fertilization (IVF)
• Testing embryos for their genetic profile prior to embryo transfer
“Third-party Reproduction”
• the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents
• May be known or anonymous
• Complex
Third-party Reproduction: Donor Egg
• Picking donor versus using an egg bank
• Identifying a donor
• Evaluating a donor
• Evaluating the intended parent(s)
• Donor stimulation/Recipient preparation
• Success rates >50%
• Cost: $25,000-30,000
Third-party Reproduction: Donor Embryo
• “Embryo Adoption”
• Evaluating the intended parent(s)
• Recipient preparation
• Legal counsel VITAL
• No good stats on success rates
• Cost: $15,000-35,000
Third-party Reproduction: Surrogacy
• Traditional Surrogacy: woman is biologically related to the pregnancy she is carrying• RISKY!!!
• Gestational Carrier: no biological relationship; carries the intended parents’ embryo(s)
Third-party Reproduction: Gestational Surrogacy
• Selection of gestational carrier (GC)
• Evaluation of GC and intended parent(s)
• Counseling
• Legal
• Recipient preparation
• Cost: $60,000 to 100,000+++
Adoption
• Various types
• Lifelong process
• Process: • Application• Home study• Identification of child (or being ID’ d)• Supervisory period• Legal adoption
• Special considerations for survivors
• Cost: $0-$50,000+++
Psychosocial Aspects
Resources
• Resolve
• Livestrong
• American Society for Reproductive Medicine (ASRM)• Reproductivefacts.org
Conclusions
• Building a family after a breast cancer diagnosis is possible
• There are many different options that are available
• Sometimes you have to reframe how you think about building your family