A diagnosis of cancer, or knowing you have genes that mean you have an elevated risk for cancer, can complicate family planning decisions. Cancer treatments can affect your fertility, while a diagnosis of “hereditary cancers,” notably breast or ovarian cancer, will likely affect plans for conception.
While making decisions about whether to preserve your fertility isn’t simple, knowing your options can empower you to take proactive steps that will match your family-building goals.
In this Q&A, Matthew Lederman, MD, and Jovana Lekovich, MD, Assistant Clinical Professors in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai and Reproductive Endocrinologists at RMA of New York, explain fertility preservation options for patients with cancer or who have a risk of hereditary cancer. Dr. Lekovich is also Director of the Oncofertility Program at the Blavatnik Family Chelsea Medical Center at Mount Sinai.
What is a hereditary cancer?
The most common hereditary cancer syndromes are the result of mutations of the BRCA1 and BRCA2 genes. These genes typically produce tumor suppressor proteins that help repair damaged DNA. However, when either of these genes is mutated or does not function properly, DNA damage is not repaired properly, and cells are more likely to develop genetic alterations that can lead to cancer.
What types of cancers are commonly seen as a result of these mutations?
Women with a BRCA mutation have an estimated 50-85 percent lifetime risk of developing breast cancer, an estimated 16-60 percent lifetime risk of developing ovarian cancer, and are at a higher risk of developing either of these cancers at much younger ages.
How can a hereditary cancer or a cancer diagnosis affect my fertility?
Individuals diagnosed with cancer or who face a risk of hereditary cancer may face issues regarding their desire to conceive, including:
- If and when to undergo risk-reducing surgery, particularly the removal of fallopian tubes and ovaries
- Potential risk of a diminished ovarian reserve, which can result in lower egg quality and quantity
- Age, which plays a role in all women’s fertility
- Desired family size
- Possibility of passing on the BRCA mutation since there is a 50 percent chance an offspring will be a carrier
What fertility options are available for cancer patients?
Patients who want to preserve their fertility may elect to freeze their eggs, a process called oncofertility, or may decide to undergo a less invasive option such as hormone monitoring.
What is oncofertility?
Cancer treatments such as chemotherapy or radiation are considered gonadotoxic treatments, which means treatments that could potentially harm your reproductive system and fertility. Oncofertility is the process of preserving fertility prior to undergoing those treatments. Eggs are frozen using a process called vitrification, which preserves them at their current age. In the future, they can be thawed, fertilized, and implanted to achieve a successful pregnancy, even if your fallopian tubes and ovaries have been removed. Embryos can also be frozen.
What is hormone monitoring?
If you are not ready to consider egg or embryo freezing but still want to be proactive, a less invasive option is hormone monitoring. Annual monitoring of your ovarian reserve includes a blood test to evaluate AMH (Anti-Mullerian hormone) and a transvaginal ultrasound of the ovaries to assess follicle count. A reproductive endocrinologist and fertility specialist can help you evaluate your fertility and decide the right time to freeze eggs and/or embryos.
How does RMA of New York work with the Blavatnik Family Chelsea Medical Center at Mount Sinai to provide fertility preservation treatments for individuals diagnosed with cancer?
Through an expedited referral process, RMA of New York works with a patient’s oncology team to schedule an appointment with a reproductive endocrinologist within 48 hours of initial contact and prior to any gonadotoxic treatments. In most cases, fertility preservation procedures can be completed within weeks of that initial appointment and scheduled around cancer diagnostic procedures and treatments. In this way, patients are able to preserve their fertility, and safely store their specimens until they are ready to focus on building a family.
To learn more about your carrier status or to assess your fertility, make an appointment with a reproductive specialist at RMA of New York.