Breast Cancer Patients Can Preserve Fertility

October is Breast Cancer Awareness month. This month, I was remembering when E! Entertainment Television Host Giuliana Rancic discovered that she had breast cancer at the age 36. She was only diagnosed because her new fertility doctor made it mandatory for all of his IVF patients to get a mammogram before starting treatment. Giuliana is forever grateful because the early diagnosis may have saved her life. At the time, Giuliana’s ability to conceive after battling cancer, was a major consideration in her decision to undergo a double mastectomy. That’s an issue many women diagnosed with cancer face in their 20’s and 30’s. On top of fighting for their lives – they often have to fight with their health insurance companies – since many won’t cover fertility preservation methods, like egg freezing.

We spoke with Dr. Jennifer Hirshfeld-Cytron, an expert in fertility preservation, to discuss what women need to know if they are diagnosed with cancer and want to protect their future chances of conceiving.

Do you see a lot of breast cancer patients who are concerned about their future fertility?

We are absolutely seeing an increase in pre-menopausal woman seeking fertility preservation for all cancers, in particular, breast cancer. Both adult and pediatric oncology societies now regard fertility preservation or “oncofertility” as a required part of standard care. It is not “an extra”.  As oncologists dramatically improve survivorship from these diseases, one’s life after cancer becomes a larger focus.

What fertility preservation options are available to women?

Women can freeze their eggs, create embryos, or pursue treatments such as ovarian tissue cryopreservation. Since 2013, freezing eggs is no longer considered experimental – treatment success is equal to we see with “fresh” eggs used during IVF. This improvement in outcomes is a reflection of advancements in egg freezing technology. From 2017 to 2018, we have seen a 30% increase in women seeking fertility preservation via egg freezing. Ovarian tissue cryopreservation is an experimental strategy where part of the ovary is removed and cut into strips. Once a patient is in remission, those strips are replaced in the ovarian fossa. This strategy has created live births, but is still considered experimental.

Who would be a candidate for fertility preservation after a breast cancer diagnosis?

The best candidates for freezing eggs or embryos are pre-menopausal women who have clearance from their oncologists to use injectable fertility medications and undergo the procedure.

How do the oncology and fertility teams work together?

Our pledge at Fertility Centers of Illinois is to see all cancer patients within 24-48 hours of request. Once preliminary testing is complete, we begin treatment immediately. We want to allow for the opportunity to freeze eggs or embryos without impacting the course of someone’s cancer treatment.

What is the fertility preservation process?

A woman begins taking injectable medication to stimulate the growth and maturation of her eggs. Injectable medication is usually taken for 8-12 days based on how the ovaries respond. While on the medication, brief ultrasound appointments are needed every 2-3 days to monitor the ovaries and egg development. At the same time, an oral medication named Letrozole is started to keep estrogen levels lower during ovarian stimulation, which is believed to be important for breast cancer patients. Blood tests are also completed to assess hormone levels related to egg growth and ovarian function. Through this testing and monitoring, we ensure everything is progressing safely. Once egg development in the ovaries has reached optimal levels, an egg retrieval is completed. The procedure is 15 minutes and requires intravenous sedation. During the procedure, the ovarian follicles (eggs) are aspirated (drawn) into a needle that is guided by ultrasonography. Women can expect to rest for the day and often feel bloated or experience minor cramping afterward. Eggs are then cryopreserved through a flash-freezing process called vitrification and stored for future use.

What should patients look for when selecting a center for fertility preservation?

It is imperative that patients find a center with extensive egg freezing experience as well as women who have returned to use their eggs and have then had children. Unlike embryo freezing, egg freezing is still very different from center to center. A successful outcome is dependent upon the experience and capabilities of the physicians and laboratory staff. It is essential to choose wisely when there is truly only one opportunity to preserve one’s fertility.

Does insurance cover these services?? If not, how can patients afford it?

Many do, but coverage will vary based on the insurance plan and geographical location of the center. For example, Illinois recently passed a law that requires insurance companies to cover egg freezing costs for women diagnosed with cancer starting in January. Other states such as Maryland, Connecticut, and Rhode Island have also made this move, with many more reviewing legislation. Many centers, including Fertility Centers of Illinois, offer discounted fees and/or medication to patients. The LIVESTRONG Fertility Program offers discounted treatment and medication to accepted applicants. The Heart Beat Program offers free medication to women diagnosed with cancer.

Can you share any stories that might offer our readers a personal perspective on this experience?

Yes, I can. A recent patient of ours was diagnosed with stage two breast cancer at 25, just two months shy of her university graduation. She is tenacious and determined – while undergoing an egg retrieval and starting cancer treatment, she fulfilled her scholastic duties and graduated on time with a 4.0 and summa cum laude honors. Her cancer treatment will conclude next summer. But another inspiring part of her story is that when a stranger reached out on Instagram, a young woman with breast cancer who was overwhelmed and scared, she offered to join her for her first fertility preservation appointment. They met for the first time at our center and have stayed connected since. The sisterhood, support and friendship that arises out of these challenging situations is nothing short of inspiring.