referral for consideration of fertility preservation options prior to treatment.
The concomitant use of GnRH is suggested, but not proven yet, to reduce gonadotoxicity of chemotherapy.
Answers to questions patients ask
1 Q1 I had breast cancer 4 years ago and my oncologist says I can now try for a baby. Will my cancer come back if I get pregnant? A1. There is no evidence from the data we have at present that pregnancy increases the risk of breast cancer returning provided you have completed the required treatment and your oncologist feels it is now safe to conceive.
2 Q2 I had cancer treatment 3 years ago and would like to try for a family now. Will the cancer treatment affect my baby? A2. No. You are generally advised not to conceive for a year after completing chemotherapy to avoid any residual effects of the drugs on the developing eggs. The incidence of abnormalities in babies born after cancer treatment is similar to that in the general population.
3 Q3 I had fertility preservation and had eight embryos frozen 3 years ago. I am now 40 and my periods have become irregular. Can I still become pregnant? A3. Yes. Whether your periods are regular or not the embryos can be transferred to the womb, with suitable hormone treatment, to achieve a pregnancy. The chance of success will depend upon the quality of the embryos after being thawed.
4 Q4 There was no time for me to freeze eggs before my cancer treatment 6 years ago when I was 22 years old. I am getting married and have regular periods. What is the chance of my having a baby? A4. Your doctor can perform tests to check your fertility. You may have a reduced “ovarian reserve” but may still be able to conceive naturally. If you need fertility treatment your doctor can advise the best option of treatment for you.
5 Q5 My periods stopped a few years ago after my cancer treatment at the age of 30 years. Will I ever be able to have a baby? A5. You probably have premature ovarian failure. However, if you only had chemotherapy for your cancer treatment, this will not affect the womb. Though you may not be able to become pregnant with your own eggs, it is possible to have a successful pregnancy with eggs from a suitable donor.
References
1 1 cancerresearchuk.org>health‐professional>breast cancer: Cancer Research UK ‐Office for National Statistics. Cancer survival in England: adults diagnosed in 2009 to 2013, followed up to 2014.
2 2 cancerresearchuk.org>health‐professional>Hodgkin‐lymphoma: Cancer Research UK.
3 3 Borchmann P, Topp MS, Behringer K, et al. Dacarbazine is an essential component of ABVD in the treatment of early favourable Hodgkin Lymphoma: results of the second interim analysis of the GHSG HD 13 trial. Onkologie. 2010; 33:124–5.
4 4 Meirow D. Reproduction post chemotherapy in young cancer patients. Mol Cell Endocrinology. 2000; 169:123–31.
5 5 Haukvik UK, Dieset I, Bjoro T, Holte H, Fossa SD. Treatment‐related premature ovarian failure as a long‐ term complication after Hodgkin’s lymphoma. Ann Oncol. 2006; 17(9):1428–33.
6 6 Hodgson DC, Pintilie M, Gitterman L, et al. Fertility among female Hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol. 2007; 25(1):11–15.
7 7 Brusamolino E, Baio A, Orlandi E, et al. Long‐term events in adult patients with clinical stage IA‐IIA non bulky Hodgkin’s lymphoma treated with four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and adjuvant radiotherapy: a single‐institution 15‐year follow‐up. Clin Cancer Res. 2006; 12(21):6487–93.
8 8 Decanter C, Morschhauser F, Pigny P, Lefebvre C, Gallo C, Dewailly D. Anti‐Mullerian hormone follow‐up in young women treated by chemotherapy for lymphoma: preliminary results. Reprod Biomed Online. 2010; 20(2):280–5.
9 9 Yuksel A, Bildik G, Senbabaoglu F, et al. The magnitude of gonadotoxicity of chemotherapy drugs on ovarian follicles and granulosa cells varies depending upon the category of the drugs and the type of granulosa cells. Hum Reprod. 2015; 30(12):2926–35.
10 10 Iqbal J, Amir E, Rochon PA, Giannakeas V, Sun P, Narod SA. Association of the timing of pregnancy with survival in women with breast cancer. JAMA Oncol. 2017 May; 3(5):659–65.
11 11 Berger JC, Clericuzio CL. Pierre Robin Sequence associated with Tamoxifen exposure. Am J Med Genet A. 2008; 146(16):2141–4.
12 12 Braems G, Denys H, Wever O, Cocqut V, Van den Broecke R. Use of Tamoxifen before and during pregnancy. Oncologist. 2011; 16:1547–51.
13 13 Anderson RA, Remedios R, Kirkwood AA, Johnson PWM et al. Determinants of ovarian function after response‐adapted therapy in patients with advanced Hodgkin’s Lymphoma (RATHL): a secondary analysis of a randomized phase 3 trial. Lancet Oncol. 2018; 19:1328–37.
14 14 Goldrat O. Kroman N, Peccatori FA, Cordoba O, Pistilli B, Lidegaard O et al. Pregnancy following breast cancer using assisted reproduction and its effect on long term outcome. Eur J Cancer. 2015; 51:1490–6.
15 15 Lambertinin M. KromanN, Ameye L. et al. Long term safety of pregnancy following breast cancer according to oestrogen receptor status. J Natl Cancer Inst. 2018; 110:426–9.
16 16 Poirot C, Fortin A, Dhédin N, Brice P, Socié G, Boissel N et al. Post‐transplant outcome of ovarian tissue cryopreserved after chemotherapy in haematologic malignancies. Haematologica. 2019; 104(8):e360–3.
17 17 Rosendahl M, Greve T, Andersen CY. The safety of transplanting cryopreserved ovarian tissue in cancer patients: a review of the literature. J Asstd Reprod Genet. 2013; 30(1):11–24.
18 18 Hodgson DC. Long‐term toxicity of chemotherapy and radiotherapy in lymphoma survivors: optimizing treatment for individual patients. Clinical Advances in Haematology & Oncology. 2015;13(2).
19 19 Sankila R, Heinavaara S, Hakulinen T. Survival of breast cancer patients after subsequent term pregnancy: “healthy mother effect.” Am J Obstet Gynaecol. 1994; 170:818–23.
20 20 Lambertini M, Moore HCF, Leonard RCF, Del Mastro L et al. Gonadotropin‐releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta‐analysis of individual patient‐level data. J Clin Oncol. 2018; 36(19):1981–90.
21 21 Demeestere I, Brice P, Peccatori FA, et al. No evidence for the benefit of gonadotropin‐releasing hormone agonist in preserving ovarian function and fertility in lymphoma survivors treated with chemotherapy: final long‐term report of a prospective randomized trial. J Clin Oncol. 2016; 34:2568–74.
22 22 Reddy N, Furness CL, Davies MC. Fertility in the adolescent and young adult patient with cancer. In: Chisholm J, Hough R, Soanes L, eds. A Practical Approach to the Care of Adolescents and Young Adults with Cancer. New York:Springer;2018.
19 The patient with abnormal cervical cytology
Martyn Underwood and William Rhys Parry‐Smith
Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Shrewsbury, UK
Case History 1: A 28‐year‐old woman with unexplained infertility is scheduled to have IVF. She has recently undergone cervical
