Breast Cancer Patients Prevent Infertility With New Treatment
Young women undergoing chemotherapy for breast cancer may be able to prevent infertility by temporarily suppressing their ovarian function with a new drug treatment, says study.
Approximately 6% of women diagnosed with breast cancer are under 40 years of age and treatment significantly compromises their ability to have children in the future. In approximately 60% of cases chemotherapy regimens and hormonal treatments can cause a woman’s ovaries to go into premature menopause, which defined by the World Health Organization as no menstrual periods for 12 months.
According to the authors of the study, this cessation of regular menstrual cycles greatly increases the risk for infertility. “Although very young women can resume menstruating (and presumably ovarian function) after more than 1 year of chemotherapy-induced [menstruation cessation], most who do not resume menstruating in the first year after the end of chemotherapy are likely to lose their ovarian function completely and permanently,” they wrote.
Treatment for this type of infertility is complex and costly, so women often resort to using donated eggs or adopting a child.
The authors of the study published in the Journal for the American Medical Association (JAMA), explained in their report that the prospects of premature menopause and infertility are the most distressing aspects of the breast cancer experience as reported by young cancer survivors. In fact, nearly 1 in 3 women choose treatment options based on reducing these risks.
Ovarian Suppression Reduces Premature Menopause by 17%
In search of way to prevent this chemo-related infertility, Italian researchers began experimenting with hormone treatment called triptorelin which suppresses ovarian function. In the Phase 3 part of their study they assigned 281 pre-menopausal women with stage I-III breast cancer to receive either a placebo or the triptorelin therapy.
According to the results of the study after one year post-chemotherapy the triptorelin group had a 17% decreased risk for developing premature menopause, despite the patient's age or type of chemotherapy used.
These results are “"intriguing and represent an important and encouraging addition to the study of ovarian preservation for women in this difficult situation," wrote Dr. Hope S. Rugo and Dr. Mitchell P. Rosen in an accompanying commentary on the study.
Menstruation is not necessarily a measure of ovarian function
However, some experts caution against jumping to conclusions about the results of this study.
Dr. Norbert Gleicher, premature menopause expert and founder of the Center for Human Reproduction in New York pointed out this is not the first time researchers have found this type of evidence.
Back in 2005 a group of researchers from Israel also reported that this type of hormone therapy, a part of a larger class of medications called gonadotropin releasing hormone antagonists (GnRH-a), are effective in preventing ovarian damage and premature menopause. However, just like the present study, the evidence is anecdotal as it measures whether or not a woman is menstruating, not her actual fertility. Dr. Gleicher explains that menstruation is not necessarily a measure of ovarian function and women can even lose their ovarian function and still have monthly menstrual bleeds.
“In other words,” he said, “just because a few more women are still menstruating after GnRH-a does not mean that they still will be able to have children with use of their own eggs.”
Rugo and and Rosen also commented that the current research is still lacking concrete proof that ovarian suppression improves fertility after chemo. However, they did stress that there is a real need to find a way to help women preserve their fertility as these risks often influence their treatment choices and adherence to a prescribed plan.
Currently, the recommended treatment for preserving fertility while undergoing chemotherapy is cryopreserving, or freezing, the woman's eggs through an in vitro fertilization (IVF) procedure.
Dr. Gleicher suggests that, although more research is needed, perhaps providers should consider the use of a GnRH-a such as triptorelin, or Lupron as an addition to cryopreserving a woman's egg before chemotherapy.
“Since one can not rely on this treatment alone, such women should still, if possible, try to cryopreserve eggs before chemo,” he said. “The data suggests [that in some women] GnRH-a may diminish ovarian damage and, therefore leave patients later better suited for [future infertility] treatments, like DHEA.”
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