Fertility treatment before chemo?

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Hi guys!

I last posted in the worried section. I was diagnosed a little over a month ago with invasive ductal breast cancer. 1 cm but no nodes. I had a lumpectomy July 7 and sentinal node biopsy. I am Estrogen and Progesterone positive, and HER2 positive. I had my first appointment with my Oncologist last week and will be getting 4 rounds of docetaxel (Taxotere) and cyclophosphamide and 18 rounds of heceptin (spaced 3 weeks apart, radiation, and then hormone therapy.

The thing is, I’m 33 and want to have children (or a child) in the future. I’ve been in touch and ready to start fertility treatment (freezing embryos) but have missed my harvest. My Oncologist said that it is a risk to do hormones but it is a ‘reasonable’ risk. She said that although they got out the cancer with clear margins, I may still have small seeds left that are not seen. She told me I must make the final decision and could not tell me what percent or anything for the risk. My chemo start date is scheduled for August 4 if I don’t do the harvesting and if I do the harvesting it will be approximately be delayed to August 27ish.

Has anyone else been through this? Any suggestions? I’m going a little crazy with worry and don’t want to risk my life but really want to be able to have a family in the future. I’m going to go on Lupron as well during treatment.

Thanks for reading!
Mary

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I was offered this as i was 32 at diagnosis. i chose not to as i have 2 lovely daughters and i was worried about the delay. Fertility wise, my periods never stopped and are still regular regardless of everyting i have been through. I have, however, been sterilised as my cancer was found 9mths after my dauhters birth and the ONC felt i was mor than fertile enough to fall pregnant again.

The specialists were every supportive of ivf for me and seemed to think the delay would make litte difference but i was bloody terrified and wanted to start chemo.

good luck
S

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Hi Mary,

So sorry your worry turned out to be bad news.

I am also 33 and was just trying for children when diagnosed.

I met with a fertility expert before I started chemo as I wanted to make informed decisions - but as my lump is very big and has definitely spread to the lymph nodes, he said he wasn’t prepared personally to take the risk to harvest some eggs. My oncologist also recommended that I started treatment immediately due to the size and risk of spread of my tumour.

Obviously my situation is different as all of the specialists recommended that I didn’t harvest eggs as my risk was significant. I’m not sure what I would have done in your situation. I desperately want children and can’t imagine not. But know I need to see if I can get through this before I worry too much about that.

I would speak to your oncologist again, or maybe get a second opinion? And see if you can speak to a fertility expert.

You can also take 1 egg from your natural cycle - but it’s very expensive and doesn’t have a particularly high success rate.

Hopefully there will be some ladies on shortly who are further down the road and will be able to offer advice from their own experiences. There are definitely a few who have posted who have had children after treatment - but I’m not sure of their stats in terms of ER positivity etc or whether they had harvested eggs or conceived naturally.

I went on a BCC Younger Women’s Forum a few weeks ago and there were workshops and seminars on topics such as fertility. It was also really useful meeting girls in a similar situation, worrying about the same thing. I would highly recommend it if you felt up to it.

Do keep in touch and let me know if you have any questions at all.

x

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Hi Mary.

I was in a similar situation - 35 at diagnosis, no kids. ER+, grade 2, 18mm tumour. Once we knew it was in my lymph nodes (3/16 nodes affected) and chemo was a definite, they referred me to the fertility clinic and I got eggs harvested/embryos frozen. My onc was happy with this decision. My chemo wasn’t delayed by very long. It wasn’t an easy process to go through, but we really wanted to have kids so decided to go with it. Have finished chemo now and on tamoxifen. Happy to discuss in more detail - PM me if you want?

Al x

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Hi

I have direct experience of this. I have Poly Cystic Ovaries, so had trouble concieving, I am now 35, was 34 at diagnosis in Feb.
We had got to the stage of IVF when I was diagnosed.
I’d been on Clomid/Clomephone to stimulate my ovaries into prodcing eggs, unfortunately I hyperstimulated on this, produced 18 eggs first time, then 9 next time and was very ill, we couldn’t have sex to try and concieve as too many eggs.

The issue they may have with you, is that they have 2 options, either a “natural cycle IVF” if you ovulate naturally, this is very expensive and time consuming, involving a lot of internal scans to monitor your natural cycle and they may not get an egg or get a good quality egg.

OR

THey can stimulate your ovaries unnaturally using Clomid, HOWEVER this sends a whole HEAP of hormones around your system and can feed the cancer if it is hormone receptor positive.

ALSO - IF you have a retreival of eggs, this means using them some time in the future, at which point being pregnant may still be dangerous for you in regards to a recurrence or new primary cancer.
9 months of high levels of oestrogen.

What I did was go and seek the opinion of the assisted conception unit.
My cancer was grade 3, 45mm Big, no node involvement but LUCKY as it well could have spread and they secretly thought it would have done.

I saw a leading fertility specialist and he said too dangerous for me to carry a baby in future, would be suicide hormone wise for me.
Couldn’t risk Clomid either as I hyper stimulate.
Unlikely to get a good quality egg naturally out of me and would have meant too long a delay in treatment.
AND I’d have to find a surrogate to carry any egg they did retrieve adn hope that egg not only survived freezing but the surrogates body would not reject it as foreign material.

SO, it’s now pretty much a NO NO. Devastating, we’d been trying for 5 years and come so far to be crushed by cancer.

THis was a unique fertility diagnosis for me, yours could be different, but what you dont want to do is not act and regret this.
I would suggest an URGENT appt with your local assisted fertility unit (within a week) to discuss options.
With the best will in the world, the Oncologists job is to keep you alive for as long as possible, what YOU need it to cover all your bases for your future happiness.

And I wish you all the best of luck with this, it’s a harrowing part of diagnosis to be potentially robbed of a future family too.

If you want to know anything else please feel free to ask me.

Your situation may well be different to mine xxx

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Hi,

I was 34, no kids and single when diagnosed. My case is slightly different from yours as mine was 2cm, Grade 3, triple negative. However I did have some eggs harvested and frozen in the 8 week gap between my reconstruction and my chemo, so started chemo about 12 weeks after my lumpectomy. The thought of never being able to have children upset me more than having to go through chemo. I was on FEC, my periods didn’t stop until the last cycle of chemo (March) and started again in May, I am hoping this is a good sign for my fertility.

If you want more detail let me know.

Jen

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Hi Mary

I was diagnosed with grade 2, 7mm, ER/PR+ IDC, no nodes age 32. No kids, did have a partner.

We decided to go for surgery and stop there. The benefits of chemotherapy are pretty small if you don’t have any nodes affected. The doctors I saw all seemed pretty sure that by having chemotherapy and tamoxifen, I would go through the menopause. We desperately wanted children.

We waited a couple of years and then had a baby, born 3 and a half years after diagnosis. All seemed well: regular scans, mammograms etc. So we decided to have another child. Seems the hormones were rather too much for the cancer to resist as I was diagnosed with a recurrence in my lymph nodes and soft tissue when pregnant for the second time. That was last June, 2010.

A year on, we have a family with two lovely girls. It’s been a hell of a year though, and the future is uncertain. There’s no sign of spread - yet - but I get the feeling that the doctors kind of assume it’s coming back sometime.

Perhaps most relevant is the fact that even now, at the age of 39 (38 at chemo) and on tamoxifen, my ovaries have recovered and I’m ovulating again. So it’s certainly possible to have the treatment and still be fertile, especially if you take Zoladex.

I wish you so much luck with your decision and the future. I know how awful it is to think you’ll never have the family you so long for. And I’m very very lucky, but it did come at a price. If I could go back in time, I’d have at least had the radiation but I’m not so sure I would change anything else.

xxxxx Jane

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The best thing you can do is ask for your precise diagnosis, and percentages.

Chemo increased my chances of survival by 16% and I had no node involvement but was Grade 3 with a large tumour. This is why its imperative that you get all the info that is unique for you.
Only then can you make a fully informed decision on how to proceed.

They knew that having 1 child was a really really big deal for me, but I already had pre-existing issues with conception. I asked for all sorts of information, like what if I don’t have chemo, what if I don’t have Tamoxifen. What if I come off after 2 years and try.
etc etc.

No matter what anyone says on here about their experience, it’s unique to them and your situation could be different.

You need to make decisions quickly too, this is so so so tough.

Most people by the way, find their eggs destroyed after treatment. So although some people are fortunate, most are not. So a retreival needs to be considered if it’s possible.

So hard to decide what to do, I really feel for you xx