How to Preserve Ovarian Function During Chemotherapy

Before undergoing chemotherapy, it is essential to have an informative conversation with women of childbearing age about the possibility of preserving ovarian function and getting pregnant after completing chemotherapy. It's crucial to know that becoming pregnant after treatment completion is not associated with a worse prognosis for women. Additionally, regardless of the tumor's receptor status, a woman can still become pregnant and give birth to a healthy child. There is no need to discourage her or convince her that this might negatively impact her health. Statistics show that 7% of women diagnosed with breast cancer are under 40 years old! Seventy-seven percent of women who have not had children at the time of diagnosis wish to become happy mothers in the future. Moreover, 88% of women report inadequate information regarding pregnancy-related issues at the time of diagnosis!

Today's post is aimed at dispelling all doubts and understanding the possibilities offered by modern medicine.

So, what are the options for preserving reproductive function?

The choice of method for preserving fertility, risks, and chances should be discussed in detail with the woman before starting therapy. Specifically, the following should be discussed:

• GnRH Analogs
• Ovarian Cryopreservation
• Cryopreservation of Fertilized and Unfertilized Eggs
• Combination of Different Methods
• Features of Endocrine Therapy

1. GnRH Analogs: This method of protecting ovarian function is discussed differently in the literature and is somewhat controversial. The results of numerous studies show a low percentage of ovarian dysfunction and a high percentage of successful pregnancies. Therefore, this method of preserving fertility can be proposed as an additional option, but not as the sole method.
2. Ovarian Cryopreservation: This procedure can be performed laparoscopically after appropriate preparation. It can be done relatively quickly, regardless of the phase of the menstrual cycle. This procedure is recommended primarily for young women with good ovarian reserve. The risks are primarily associated with the laparoscopy procedure itself: bleeding and infection. Importantly, after extracting ovarian tissue, it should be histologically confirmed that there are no malignant cells.
3. Cryopreservation of Fertilized and Unfertilized Eggs: This is a reliable and established method that can be initiated at any point in the menstrual cycle. Patients with breast cancer need to supplement the stimulation protocol with anti-hormonal medications (such as letrozole) to maintain a low estrogen level. To perform ovarian stimulation with egg retrieval, approximately 14 days need to be allotted.
4. Combination of Different Methods: This method is used to increase the chances of future pregnancy. The possible protocol and timeframes include ovarian cryopreservation followed by ovarian stimulation for egg retrieval and the administration of GnRH analogs before starting chemotherapy (see the diagram in the picture).
5. Features of Endocrine Therapy: When undergoing endocrine therapy, protective measures can be offered. Since endocrine therapy is conducted for 5-10 years, it is possible to interrupt it for 2-3 years for pregnancy and childbirth, followed by a discussion of continuing the treatment.
6. It's essential to provide women with comprehensive information about these options, including their benefits, risks, and potential outcomes, so they can make informed decisions about preserving their fertility during breast cancer treatment.