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?
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Fertility as a Survivorship Issue
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
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
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Discussion of fertility impact
should be part of informed consent to cancer therapy
Loss of Eggs is Faster for Survivors
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Max p
ote
nti
al in
u
tero
7M
1-2M
Structure of the Ovary
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Estimated Risk of Gonadotoxicity
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
• 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
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Letourneau et al. Cancer 2012
60%
25%
How does the brain fit?
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Fertility preservation options before breast cancer treatment
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Oophoropexy Egg/embryo
banking Ovarian tissue
banking Donor eggs,
adoption Gestational carrier
Established Options for Post-Pubertal Females
Is egg/embryo banking safe?
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Azim et al. JCO 2008
Emerging Options for Pre/Post-Pubertal Females
use of GnRH agonists
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
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
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Kondapalli & Gracia, 2010
no delay in treatment, can be combined with other procedures to minimize anesthesia
Emerging Options for Pre/Post-Pubertal Females
ovarian tissue cryopreservation
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Emerging Options for Pre/Post-Pubertal Females
ovarian tissue transplantation
No delay in treatment
Not appropriate in hematologic cancers
~40 live birthsSilber et al. NEJM 2005
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Fertility testing and options after
breast cancer treatment
Assessing Fertility Status
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Special blood tests that are timed with your menstrual cycle anti-mullerian hormone FSH estradiol
Pelvic ultrasound Hysterosalpingogram
Assessing Fertility Status
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Fertility Treatment Options
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Fertility medications (oral, injections) use of aromatase inhibitors
Artificial insemination In vitro fertilization Preimplantation genetic diagnosis Comprehensive chromosomal
screening
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
Preimplantation Genetic Diagnosis
Oncofertility Resources
Oncofertility Program | Department of Obstetrics & Gynecology
Expanding parenthood options for life after cancer
http://arm.coloradowomenshealth.com/service/oncofertility
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