Fertility
Treatment of early breast cancer effects ovarian function and fertility in pre-menopausal women. Some women now choose to delay conception to a later age, when potentially a diagnosis of breast cancer may occur. Although many women are cured of their brea
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Fertility Stuart Lavery and Georgios Christopoulos
Abstract Treatment of early breast cancer effects ovarian function and fertility in pre-menopausal women. Some women now choose to delay conception to a later age, when potentially a diagnosis of breast cancer may occur. Although many women are cured of their breast cancer long term, the opportunity to have children has to be explored at the time of diagnosis to allow the use of potential measures to preserve fertility options in the future. This chapter explores the systemic effects of chemotherapy on ovarian function, and fertility sparing measures available to women. Overall, the evidence in the literature suggests that subsequent pregnancy does not appear to adversely effect long-term breast cancer outcomes. Keywords Fertility • Premature ovarian insufficiency (POI) • AMH • GnRH agonists • IVF • Cryopreservation • Pregnancy
Introduction It is estimated that 5–7 % of breast cancers occur in women under the age of 40. As one quarter of first live births occurs between the ages of 30 and 40, many women will be nulliparous at the time of diagnosis [1]. However less than 10 % of women diagnosed with invasive breast cancer less than the age of 40 will subsequently have children after treatment [1]. In a large survey of women with breast cancer, 29 % reported that fertility concerns influenced their treatment decisions and only 51 % felt that these concerns were adequately addressed by their doctors [2]. The potential effect of cancer treatment on fertility and ovarian function should be discussed with all breast cancer patients of reproductive age. An early discussion will allow patients and doctors to consider and plan appropriate fertility preservation
S. Lavery, MBBCh, MSc, MRCOG (*) • G. Christopoulos, MD, MRCOG Department of Reproductive Medicine Hammersmith and Queen Charlotte’s Hospitals, Imperial College Healthcare NHS Trust, London, UK e-mail: [email protected] © Springer International Publishing Switzerland 2016 A. Ring, M. Parton (eds.), Breast Cancer Survivorship, DOI 10.1007/978-3-319-41858-2_15
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treatment. Routine fertility preservation strategies, such as oocyte or embryo cryopreservation, usually require at least 2 weeks from the onset of treatment. Consequently any cancer treatment such as chemotherapy may be delayed, sometimes for more than 1 month. A new diagnosis of breast cancer carries a significant psychological burden. When women with breast cancer are asked to make important decisions regarding their long-term fertility at the same time, they should be offered multidisciplinary support, expert advice and adequate time to reach a decision. Conversely for patients that will not require chemotherapy, an immediate referral to fertility experts for counseling may overestimate the need of fertility preservation strategies, which highlights the complex nature of the timing and content of fertility counseling for these women. The number of oocytes present in the ovaries progressively declines u
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