Preserving fertility in women with cancer | Gynae Cancer Doctor Bangalore

1. PRESERVING FERTILITY IN WOMEN WITH CANCER Presented By Dr. Rani Bhat

2. Although cancer incidence rates in women less than 50 years of age continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in cancer treatment. In 1990 the incidence of cancer survivors was 1 in 1,000 for young adults (15–45 years of age) and by 2010, as many as 1 in 250 patients in this age group would have survived cancer. However, increasing numbers of survivors are now confronted with the long-term consequences of exposure to these cancer treatments. Cancer therapy such as surgery, radiotherapy, and chemotherapy, can have a profound impact on ovarian function, leading to premature menopause and loss of fertility.

3. How does chemotherapy affect fertility in women? • Most chemotherapy drugs (medicines to destroy cancer cells) can damage a woman’s eggs (ovarian follicles), affecting her fertility. This affect will depend on the woman’s age, the types of drugs she gets, and the drug doses. • Chemotherapeutic drugs that can cause egg damage and infertility are Carboplatin, busulfan, carmustine (BCNU), chlorambucil, cisplatin, cyclophosphamide, doxorubicin/adriamycin, ifosfamide, lomustine (CCNU), mechlorethamine, melphalan, procarbazine, temozolomide.

4. What should I know about chemotherapy & pregnancy? • Age at the time of chemotherapy makes a difference • After chemotherapy, fertility may be of shorter duration • You need to understand that having regular menstrual periods after chemotherapy doesn’t always mean fertility • During chemotherapy treatment you need to avoid getting pregnant • If you get pregnant immediately after chemotherapy, it can harm the baby

5. Will radiation therapy affect fertility in women? • Radiation treatment is a mode of treatment wherein high-energy rays are used to kill cancer cells. Even with the best radiation machines available along with cancer cells, normal cells in the surrounding gets high-energy rays and get damaged. • When radiation is given to the pelvic area these rays can also damage ovaries. High doses of radiation, when used (in cases such as Cervical /endometrial/ sarcoma), can destroy some or all of the eggs in the ovaries and can lead to infertility or early menopause.

6. Surgery as part of the treatment for cervical, endometrial or can cause infertility. ovarian cancer How will cancer surgery affect fertility in women? • In some women with early-stage ovarian cancer, we do something known as fertility-sparing surgery wherein we only remove the ovary with cancer and retain the uterus and opposite normal ovary, this procedure is offered only to those women who have very early ovarian cancer.

7. Other treatments that can affect fertility in women • Breast cancer: during breast cancer treatment hormonal therapies may be advised, commonly used drug is tamoxifen and during this treatment, women can still get pregnant hence you will be advised to use effective birth control methods because if you conceive while taking tamoxifen fetus can develop birth defects.

8. Way to preserve fertility 1. Egg (oocyte) freezing 2. Embryo freezing 3. Fertility-sparing surgery (for ovarian cancer) 4. GnRH agonist treatment (ovarian suppression) 5. Ovarian transposition

9. CONTACT INFORMATION HOSPITAL ADDRESS EMAIL ADDRESS No: 8, P. Kalinga Rao Road, Sampangi Ram Nagar, Bangalore,Karnataka 560020 PHONE NUMBER info@drranibhat.com 8861432428 www.drranibhat.com