FAMILY PLANNING AFTER BREAST CANCER Laxmi A Kondapalli, MD MSCE Assistant Professor, Reproductive Endocrinology & Infertility Director, Fertility Preservation

FAMILY PLANNING AFTER BREAST CANCERLaxmi A Kondapalli, MD MSCE

Assistant Professor, Reproductive Endocrinology & Infertility

Director, Fertility Preservation Program

Department of Obstetrics and Gynecology

University of Colorado Denver

Oncofertility Program | Department of Obstetrics & Gynecology

Expanding parenthood options for life after cancer

Disclosure

The speaker has no financial or other conflict of interest

Objectives

how does breast cancer and its treatment affect fertility?

what fertility preservation options are available before and after treatment?

how can I evaluate current fertility status?

is pregnancy safe after breast cancer?



Fertility as a Survivorship Issue



1Armuand GM et al, 20122Trottman L et al, 2007

3Letourneu JM et al, 2012

40% of survivors do not recall discussing fertility impact of cancer treatment with oncologist1

24% of young male cancer patients pursued sperm banking2

4% of young female cancer patients pursued fertility preservation3

1.6M new cancer cases with ~10% younger than 45 years

ASCO and ASRM Guidelines



Discussion of fertility impact

should be part of informed consent to cancer therapy

Loss of Eggs is Faster for Survivors



Max p

ote

nti

al in

u

tero

7M

1-2M

Structure of the Ovary



Estimated Risk of Gonadotoxicity



• Alkylating chemotherapy • Cyclophosphamide, ifosfamide• Busulfan, mephalan

• Total body irradiation , stem cell transplant

High (>80%)

• Platinum-based chemotherapy• Cisplatin, carboplatin

• Adriamycin Moderate

• Cell cycle dependent agents• Methotrexate, vincristine,

bleomycin

Low (<20%)

Normal Periods ≠ Normal Fertility



Letourneau et al. Cancer 2012

60%

25%

How does the brain fit?





Fertility preservation options before breast cancer treatment



Oophoropexy Egg/embryo

banking Ovarian tissue

banking Donor eggs,

adoption Gestational carrier

Established Options for Post-Pubertal Females

Oocyte & Embryo Cryopreservation

Oocyte & Embryo Cryopreservation

Is egg/embryo banking safe?



Azim et al. JCO 2008

Emerging Options for Pre/Post-Pubertal Females

use of GnRH agonists



Mechanism unknown Apoptosis Impaired perfusion Induce protective

factorsConflicting results Retrospective studies with historical

controls Use of surrogate outcomes (return of

menses) Need for RCT

role in hematologic malignancies



Kondapalli & Gracia, 2010

no delay in treatment, can be combined with other procedures to minimize anesthesia


ovarian tissue cryopreservation




ovarian tissue transplantation

No delay in treatment

Not appropriate in hematologic cancers

~40 live birthsSilber et al. NEJM 2005



Fertility testing and options after

breast cancer treatment

Assessing Fertility Status



Special blood tests that are timed with your menstrual cycle anti-mullerian hormone FSH estradiol

Pelvic ultrasound Hysterosalpingogram

Assessing Fertility Status



Fertility Treatment Options



Fertility medications (oral, injections) use of aromatase inhibitors

Artificial insemination In vitro fertilization Preimplantation genetic diagnosis Comprehensive chromosomal

screening

Preimplantation Genetic Diagnosis



Preimplantation Genetic Diagnosis

Oncofertility Resources



http://arm.coloradowomenshealth.com/service/oncofertility

myoncofertility.orgsavemyfertility.org

Oncofertility Funding

Academic Enrichment Fund

NIH 5K12HD001271-13

FAMILY PLANNING AFTER BREAST CANCERLaxmi A Kondapalli, MD MSCE

Assistant Professor, Reproductive Endocrinology & Infertility

Director, Fertility Preservation Program

Department of Obstetrics and Gynecology

University of Colorado Denver

Documents

FAMILY PLANNING AFTER BREAST CANCER Laxmi A Kondapalli, MD MSCE Assistant Professor, Reproductive Endocrinology & Infertility Director, Fertility Preservation