Fertility preservation in young women with breast cancer

Fertility preservation in young  women with breast cancer

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Worldwide, breast cancer Treatment in India is the most frequently diagnosed  Breast Cancer in women.
The rates of breast cancer incidence in indian women has increased dramatically
in the last two decades, and it has become the most commonly diagnosed type of
cancer in urban populations. More troubling is the fact that today, women are
being diagnosed at a younger age, which may be partly attributable to lifestyle changes.
Breast cancer in a young woman has an inherently aggressive nature and this adds
further to the psycho-emotional impact of being diagnosed with cancer. Most, if not
all, need aggressive treatment with surgery,  radiation therapy, chemotherapy,
hormonal treatment and life long follow up with their Best oncologist in India.
Modern treatment protocols for breast cancer are yielding ever-higher cure rates,
but more often than not, the price paid for survival is the loss of reproductive function.
Infertility is functionally defined as the inability to conceive after 1 year of
intercourse without contraception. Rates of permanent infertility and compromised
fertility after breast cancer treatment in India vary and depend primarily on the type of
chemotherapy used. Surgery and radiation therapy, being local treatments directed at
the breast, do not affect fertility. The rate of amenorrhea according to the
type of chemotherapy Treatment in India and age of patient is shown below:

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Rate of infertility

1. Age more than 40 yrs Between 30 to 39 yrs Less than 30 yrs 80% or more(High)
2. CMF, FEC, FAC EC EC 20 - 80%(Moderate)
3. AC CMF, FEC,
4. FAC
5. 20% or less(Low)
6. AC CMF, FEC, FAC

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Till date, there is no evidence of negative impact of subsequent pregnancy after
treatment on survival. Several case-control and retrospective cohort studies have not
shown a decrement in survival or an increase in risk of recurrence with
pregnancy Most young women are inadequately
counseled about infertility, as the priority for the patient and her family is usually
'cure'. However, the available evidence suggests that fertility preservation is of
great importance to many women diagnosed with cancer, and that infertility
resulting from chemotherapy may be associated with psychosocial distress.
 Although cancer survivors can become parents through options such as adoption
and surrogacy, most prefer to have a biological offspring.
The options for fertility preservation in women are:
Embryo cryopreservation
Ovarian suppression
Oocyte cryopreservation
Ovarian cryopreservation and
reimplantation

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EMBRYO CRYOPRESERVATION

The most well established method is embryo cryopreservation and it has been
used routinely for storing surplus embryos after in vitro fertilization for infertility
treatment.

This approach typically requires approximately two weeks of ovarian
stimulation with daily injections of follicle- stimulating hormone from the onset of
menses. Follicle development is monitored by serial ultrasounds and blood tests. At
the appropriate time, an injection of HCG is administered to start the ovulatory
cascade, and oocytes are subsequently collected by ultrasound guided
transvaginal needle aspiration under sedation. Oocytes are fertilized in vitro and
cryopreserved after fertilization. For women with hormone-sensitive
tumors, alternative hormonal stimulation approaches such as letrozole or tamoxifen
have been developed to theoretically reduce the potential risk of estrogen
exposure.

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