In a nutshell
This study looked at fertility preservation (FP) in patients with breast cancer. It found that many patients choose FP before chemotherapy and that most patients have a return of ovulation following treatment.
Some background
12% of patients newly diagnosed with breast cancer are under 40 years of age. Preserving fertility is a concern for many patients of childbearing age. However, most patients in this age group are given chemotherapy after surgery to increase the effectiveness of surgery. This chemotherapy causes the ovaries to fail for 20% of patients.
FP uses ovarian stimulation medication to collect and freeze eggs prior to chemotherapy. FP may also use in vitro fertilization (IVF) to freeze embryos. FP specialists are becoming more common over time. It is unclear how FP affects patients of childbearing age with breast cancer.
Methods & findings
118 women under the age of 41 with early breast cancer were counseled on FP. All of the patients were pre-menopausal.
34 patients (29%) chose to undergo FP before chemotherapy. These patients were more likely to have no children (85% vs. 63%) and to have a male partner (88% vs. 70%). They were also more likely to have a small tumor (19 mm vs. 25 mm). 97% of patients who pursued FP were able to successfully freeze eggs and/or embryos.
Menstrual cycles stopped during chemotherapy for all but four patients. However, 68% of patients had ovulation return within two years of completion of chemotherapy. Within five years, 92% had ovulation return. The average time until the return of fertility was 9 months.
Three of the patients used their frozen embryos. Of these, two had a return of ovarian function but used the frozen embryos to screen for the BRCA-1 cancer gene. The third woman did not conceive despite the use of frozen embryos. Ten patients in the FP group had twelve babies. In addition to the two pregnancies with frozen embryos, nine pregnancies were spontaneous. One used intrauterine insemination. Sixteen patients in the non-FP group had children, and they had 20 babies. One pregnancy used IVF, and the rest were spontaneous.
The rates of not having the cancer return within five years were similar for the FP and non-FP groups.
The bottom line
This study found that FP is a safe option for women of childbearing age with early breast cancer.
The fine print
The study did not collect information on how many patients attempted to conceive following chemotherapy.
Published By :
Breast Cancer Research and Treatment
Date :
Mar 31, 2020
