CALL US AT: (877) 838.BABY


Archive for the ‘Breast Cancer’ tag

Balancing Breast Cancer and Fertility Preservation

By Steven Brenner MD

October 9th, 2016 at 5:22 pm

 

Dr. Steven Brenner


A diagnosis of breast cancer is one of the most challenging health issues a person could face.  This diagnosis is even more devastating to the woman who desires to have children the future.  Treatments for the breast cancer may have harmful effects on the woman’s ability to conceive by adversely affecting the health of her eggs.  In addition, the hormonal treatments frequently used to help an individual conceive have the potential to worsen the breast cancer.

There is often turmoil surrounding the diagnosis of breast cancer.  The individual, her family and physicians are appropriately focused on getting rapid effective treatment and survival.  The issue of fertility may not be thought of until a chemotherapeutic plan is just about to start or has already been initiated.

Since there are fertility preserving options for the individuals facing breast cancer treatment, these options should be considered.  If time allows eggs or embryos may be frozen for future use.  The use of such procedures depends on many factors, primarily, will such treatment have a negative effect on the woman’s disease.  If in the patient’s and oncologist’s judgment fertility preservation is an option it should occur rapidly to allow for the timely treatment of the breast cancer.

The key is for the oncologist and patient to be aware and discuss the potential for fertility conservation treatment prior to the start of chemotherapy.  This opportunity for discussion may be lost in the unrest that surrounds the diagnosis.  Breast cancer awareness month, October, 2016, creates a platform to raise these issues and help both individuals and health care providers come more cognizant of available treatments and the importance of timing these treatments to maximize future fertility.

Long Island IVF offers women facing cancer the fertility preservation options of elective embryo- or egg-freezing prior to undergoing chemotherapy. This enables the woman to safeguard some of her eggs from the adverse effects of chemotherapy by retrieving and freezing them before she begins her cancer treatment. Her frozen eggs or embryos will be there for her use in family-building once her cancer battle is behind her. For more information, please contact our office at 877-838-BABY.

 

* * * * * * *** ***

 

Would you consider fertility preservation or mention the option to a friend facing a cancer diagnosis?

no comments

Fertility Awareness Opportunities Angelina Jolie Missed

By Tracey Minella

September 20th, 2016 at 10:11 pm

Public Domain Image: courtesy of publicdomainpictures.net/vera kratochvil-wax figures

 

[This post was originally posted in March, 2015. It's being reprinted as a reminder of what we can learn from the health care decisions Angelina Jolie bravely made and shared publicly.]

Actress, director, humanitarian, ambassador, mom of twins, adoptive mom, wife of Brad Pitt. And she’s gorgeous.

What’s not to hate?

Oh, I’m just sort of  kidding. No, really. But despite all the good she does, there will always be haters. People who want her money, her talent, her babies, or her man. Jealousy can do that.

I don’t admire many celebrities… and that’s fine, because their only job is to entertain me, not impress me. But I am impressed with Angelina Jolie. She’s charitable with her time and money and seems pretty grounded for a megastar. And she uses her celebrity for good.

It’s been only two years since Jolie made headlines for undergoing a preventative double mastectomy after testing positive for the BRCA gene mutation… a mutation that significantly increases the lifetime risk of getting breast cancer. At that time, she was open about her decision and used her celebrity to increase breast cancer awareness.

This week, Angelina revealed that she took those preventative measures to the next level. This time, she had both of her ovaries and fallopian tubes removed in the hope of avoiding ovarian cancer…another deadly cancer linked to the same gene mutation. Jolie lost her mom to ovarian cancer and said in a recent New York Times Op Ed piece that she doesn’t want her children to experience the same loss. Her openness is raising awareness of ovarian cancer.

But there is another untold story here, too…a fertility awareness story…and it needs to be heard.

Unless you’ve been hiding under a rock, you know Jolie has six children. She adopted three children internationally and gave birth to a singleton and a pair of twins. Practically eliminating her risk of getting ovarian cancer is not the only result of her surgery.

The media is reporting that she can no longer have biological children. And Jolie acknowledged how hard her decision would be for a woman who has not completed her family-building. Perhaps because of the size of her family, this point seemed lost on the general public. But it’s not lost on you, is it? This surgery is a big deal. And before others who may not be done with their family-building journeys emulate Jolie and follow her path, some crucial missing information needs to be shared.

In fact, there are three opportunities here to increase fertility awareness and educate the public about advances in the field of reproductive technologies, namely PGD, Egg donation, and Egg-freezing.

First, there’s pre-implantation genetic diagnosis (“PGD”). PGD enables couples who are concerned about passing a life-threatening genetic disease on to their children to have their embryos pre-screened for gene mutations. This screening can only be done in conjunction with an in-vitro fertilization (IVF) procedure, where eggs are retrieved and fertilized in a lab and the resulting embryos can be tested. Then, only those embryos that did not test positive for the mutated gene would be transferred into the uterus…virtually eliminating the chance of passing on that hereditary disease. BRCA is one of the many genes that can be screened through PGD. Long Island IVF offers PGD.

Second, there’s egg donation. If a woman has her ovaries and tubes removed, she cannot thereafter have a biological child…one created using her own eggs… however she may still experience childbirth. If she still has a healthy uterus, it may be possible for her, through IVF, to use eggs from an egg donor and the sperm of her partner or a donor, and have the resulting embryos transferred into her uterus where a pregnancy can implant and grow to term. Long Island IVF’s Donor Egg Program brought Long Island its First donor egg baby decades ago.

Finally, there’s the latest breakthrough in women’s fertility preservation technology: egg freezing. Egg-freezing offers an exception to the egg donor statement above. If… prior to removing her ovaries… a woman undergoes IVF for the purpose of either freezing her retrieved eggs (or freezing the embryos resulting from the fertilization of her retrieved eggs), then instead of needing donor eggs, she would be able to later have her own frozen eggs or embryos thawed and transferred into her uterus in the hope of becoming pregnant with her biological child. Or if her uterus was unsuitable or absent, she could still have a biological child by having someone else carry a pregnancy for her. (Note: Surrogacy and gestational carrier laws vary from state to state.) Long Island IVF has an Egg Freezing Program.

These three fertility awareness opportunities, when coupled with Jolie’s breast cancer and ovarian cancer awareness, will further empower women everywhere to make better medical choices and take charge of their fertility and general health.

Shame on the haters. It’s wonderful that Jolie is open about her health in a way that raises awareness for others. She is a just a mom. A selfless mom who just wants to be there to see her children and future grandchildren grow up.

Is there something wrong with being proactive after tests show you carry a gene that could one day take your life, like it took your mother’s? Are the haters just jealous of her? Is she a hero?

* ** * * * ******** *** * **

What do you think? What would you do?

 

 

no comments

Do I Need a Pre-IVF Mammogram?

By Tracey Minella

October 20th, 2011 at 11:51 am

It’s hard not to jump on the bandwagon and flat out say “Yes!” after hearing the news this week that reality TV star, Guiliana Rancic, 36, was recently diagnosed with breast cancer after her new RE insisted she have a mammogram before going forward with her third IVF cycle.

But even though many of us have been routing for her and her husband, Bill Rancic (of “The Apprentice”) since they courageously made their infertility battle public…and even though it happens to be breast cancer awareness month… we should be wary of getting swept up in our collective heartbreak for Mrs. Rancic and demanding pre-IVF mammograms for all patients.

Should the accepted standards of medicine regarding mammograms be modified because of her rare case? Is the exposure to radiation a risk worth taking in light of the slim chance of detecting cancer in younger patients without known risk factors?

In the general population, mammograms are not recommended by either the National Cancer Institute or the American Cancer Society for women under 40.

Further, with respect to women about to undergo IVF, neither the American College of Obstetricians and Gynecologists, nor the American Society for Reproductive Medicine (ASRM) recommends mammograms before age 40. Just a pap and breast exam.

Of course, if there is a family history or a patient has tested positive for the breast cancer gene mutation, screening may be indicated earlier.

Despite the continued lack of evidence after many studies, of a causal connection between IVF and cancer, there remains a skepticism or fear among some of the public. And it rears its ugly head in cases like these. For right on the heels of Monday’s announcement, the Today show had to do a follow up interview due to “hormone phobia”. Did Rancic’s first two IVF’s cause the breast cancer?

I wince when I see this because I see IVF taking an undeserved step backwards in the public eye. I can only hope people look past the sympathetic face of the beloved celebrity and really hear the answer from Dr. Nancy Snyderman: “Take this as a stand alone case.” 

People have been taking IVF meds and birth control meds…both of which are hormones…for decades. Women tend to seek IVF when they are older. Women tend to get breast cancer when they are older. “There is an age relation, not a hormonal relation” between IVF and breast cancer, Dr. Snyderman reassured.

Rancic, who is recovering from Tuesday’s lumpectomies and will need radiation treatments, had been stimulating at the time of her diagnosis and underwent the retrieval, but no transfer. We wish her only the best in her recovery and in her future family-building efforts.

I loved her closing remarks in her interview on Today when she confirmed her plans to get pregnant through IVF after her cancer treatment. “I’m not going to give up. I want that baby. What’s amazing is… that baby will have saved my life.”

You can see both interviews…Guiliana’s announcement and Dr. Snyderman’s interview …here: http://vitals.msnbc.msn.com/_news/2011/10/17/8368474-doctors-ivf-not-to-blame-for-rancics-breast-cancer.

The bottom line is that you as the patient need to be comfortable. Please speak to your OB/GYN and your RE about your concerns and questions so they can help you determine if a mammogram is called for in your particular case.

Good luck, Guiliana and Bill. And good luck to everyone on their family-building journey.

* * * * * * * * * * * **

Do you think all IVF patients should get pre-IVF mammograms regardless of age? Do you worry about having or getting breast cancer as a result of IVF? Have you spoken to your RE about your concerns?

no comments

Breast Cancer Awareness Month and Your Fertility

By Tracey Minella and David Kreiner MD

October 4th, 2011 at 9:52 pm

October is National Breast Cancer Awareness Month.

Sometimes, women undergoing infertility treatment…treatment that may take longer than they initially expected… neglect their regular GYN appointments. That means they may miss having their annual mammography to screen for breast cancer.

So here’s a timely reminder to all you women to pick up the phone if you’re overdue for your appointment.

Dr. Kreiner, of East Coast Fertility, has some encouraging news for women who have not yet begun or finished their family-building, but are battling breast cancer:

Today, women living with breast cancer become fertility patients

Historically, women stricken with breast cancer were pitied for their loss of their sensuality… if not sexuality… including, among other things, their roles as lovers and pregnant and lactating mothers.  Treatment of the disease was aimed at aggressive resection of the disease to save these often young women.  Surgery traditionally included a total mastectomy (if not bilateral) and sometimes included disfiguring lymph node dissection.  Postoperative chemotherapy has been effective, but resulted in suppression of ovulation and pregnancy.

Given the choice between potential survival with total mastectomies or preservation of the breast, most surgeons and their patents have opted for the surer path to preservation of life which meant undergoing aggressive and often radical surgery.  Future fertility was not a right these women could claim lest they increased their risk that the disease would spread if they significantly delayed chemotherapy.

Happily, recent events have radically changed medicine’s approach to women living with breast cancer.  The latest studies indicate that resection of a localized tumor has the same survival rates as total mastectomies, and suggest that a woman with breast cancer may not need the disfiguring surgery which could drastically alter her feminine body image. In addition, reproductive technology can now offer freezing of these women’s eggs and embryos so that we can now safely preserve her fertility as well.

Women need no longer feel defined by their disease…breast cancer.  

Instead, modern conservative surgery, combined with egg or embryo freezing (prior to initiating chemotherapy or prior to oophorectomies removing the native source of estrogen), allows these affected women to maintain a positive body image and preserve their fertility for the day when their breast cancer can take second place to their fertility and childbearing needs.  

* * * * * * * * * * *

Have you faced breast cancer? How has it affected your fertility plan?

no comments

Fertility-Saving Options for Breast Cancer Patients

By Tracey Minella

February 23rd, 2011 at 12:00 am

When you’re trying to conceive and you can’t, and then you go to a fertility specialist for help, and it still doesn’t happen, some women might think their life is over. That nothing could be worse. That no one has it harder than they do. That there’s no reason to live.

Sure that sounds melodramatic to anyone who hasn’t faced down infertility… who hasn’t faced the possibility that the most maternal of our instincts and desires and needs could be denied. But while the infertile woman is absolutely justified in feeling the whole range of emotions that accompany her diagnosis, things could actually be worse.

“What could possibly be worse than being infertile?” you ask.

You could have breast cancer.

It wasn’t too long ago that a breast cancer diagnosis, with its accompanying chemotherapy and/or radiation, and/or removal of the ovaries, meant the end of a woman’s dream of having a biological child. The focus…and rightly so…was on saving her life, not her breast, not her fertility.

Fortunately, women have more options today. Advances in reproductive technology can now offer women the chance to freeze their eggs or embryos prior to undergoing chemo or radiation or prior to surgically removing her ovaries. That way, women can preserve their fertility for a future time when their breast cancer is no longer their primary focus.

Some breast cancer survivors, like Christina Applegate, are lucky. They do not do chemo or radiation so their fertility is not compromised by their cancer treatment. She gave birth to a beautiful baby girl last month. But thanks to egg and embryo freezing now, and IVF later, more breast cancer survivors will be able to enjoy that same miracle.

One would like to think that oncologists and primary care doctors would routinely refer young cancer patients who have yet to start or complete their families to a reproductive endocrinologist for a consultation prior to chemo or radiation or oophorectomy. Many do, but for those that don’t, it’s an omission that can’t be remedied later.

Even if the referral is recommended, when faced with the diagnosis of cancer, can a patient even wrap her mind around saving her fertility when she fears mortality? And if so, does her cancer allow her the time to explore this option? And what about the very young patients, whose health care is effectively still in the hands of their parents? Will they even think about their “baby’s” future plans to have a baby when overwhelmed by a parent’s worst nightmare? That’s why we all need to help increase public awareness of fertility-saving options.

So file this bit of information away and hope you never need to use it:

If any female you know (except post menopausal women)…especially the youngest of girls… is ever diagnosed with breast cancer, tell her or her spouse or parent to see a reproductive endocrinologist before having chemo or radiation or before removing her ovaries, if her cancer treatment protocol can accommodate the delay. You just might save her fertility.

Can your friends and family count on you to share this information if need be?

2 comments

Breast Cancer and Infertility

By Dr. Jessica Mann

November 5th, 2010 at 9:11 am

Breast cancer is the second leading cause of cancer-related death in women of reproductive age.  Unlike cervical cancer, where the papanikolau test has proven to save lives, diagnosing early breast cancer in premenopausal women continues to be a challenge and no screening test is available to date for women in their 30’s.  Recently, there has been a rise in the number of women of advanced reproductive age seeking fertility treatments.  To date, no study has found a causal relationship between the use of assisted reproduction and breast cancer.  Moreover, as women are winning the battle against cancer, attention has been turned to quality of life of cancer survivors as well as the possibility of childbearing.  Studies have shown that survivors of breast cancer can indeed have a safe pregnancy and remain free of disease and the recommendation is to attempt conception no earlier than two years after being in remission and thought to be cured. 

With the advent of assisted reproduction the options have increased.  We can offer emergency in vitro fertilization utilizing protocols that minimize exposure to high levels of estrogen, which are detrimental in patients with breast cancer.  The concept is to stimulate production of multiple eggs, fertilize them, and freeze embryos which would be stored for later use.  The process can take as little as 14 days.  Depending on the patient’s cycle, the patient can be placed into a state of ovarian quiescence followed by controlled hormonal stimulation with injections for 10-14 days.  During this time, careful monitoring of hormonal response as well as growth of ovarian follicles, which contain the eggs is performed via ultrasound measurements.  The last part of the process includes induction of ovulation, which is accurately timed so that the eggs can be retrieved at the perfect time.  Following retrieval of the eggs, the patient can safely proceed with chemotherapy administration as deemed appropriate by the medical oncologist. 

The creation of embryos prior to chemotherapy treatment has two main advantages over ovarian stimulation after cancer treatment.  First, it allows a woman to use her eggs at an earlier age than if she was to wait for cancer treatment.  This is associated with lower likelihood pregnancy loss and improved chance of conception.  Second, it provides that woman some reassurance that even if her ovarian reserve is severely compromised by chemotherapy drugs, she will have a chance of conception utilizing embryos that were cryopreserved prior to the treatment of cancer. 

For women who do not have a partner, options include using an anonymous sperm donor to create embryos as well as egg freezing, the latter being available only in specialized centers for now. 

The options described do not apply exclusively to patients with breast cancer.  The diagnosis of cancer has many physical and psychological implications for patients.  The amount of information can be overwhelming.  A team approach consisting of patient support groups as well as medical trained professionals is needed for successful treatment.  Education and information is important for patients.   Options counseling for cancer patients should include a discussion of reproductive alternatives when dealing with women of childbearing age.   

no comments


The Fertility Daily Blog by Long Island IVF
© Copyright 2010-2012