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The Center for Fertility and Gynecology

Dear Dr. Marc.... Fertility after cancer

By on April 12, 2013

This question and answer was originally published on the blog clomidandcabranet.com by Katie: "Infertility Warrior, Mommy to two, wife of rock and roller, Child and Adolescent Pshcyotherapist , and Parenting Expert in Los Angeles, CA"  

Dear Dr. Marc,

I am a 35 yo mother of one healthy 5 1/2 yo boy (conceived quite naturally on month 1 of trying).  When we began to try for our second child, we had troubles.  Tried for 18 months with just one chemical pregnancy.  When I was 32, I was dx with Non-Hodgkins Lymphoma and treated with 6 rounds of RCHOP and a month of radiation to my chest.  My period returned and I conceived spontaneously less than a year after completing treatment, which did leave me in remission, thank goodness.  However, an RE put me on progesterone, which I had an allergic reaction to and when I stopped taking it, I miscarried at 6 weeks.  My husband has also been through a number of SA with flying colors.

Now, we've been trying again for the better part of the past year with no luck.  One round of femara/IUI and I'm in the middle of a second.  I have now finally been giving a diagnosis of DOR, with an FSH of 15.5 this cycle and just 5 small follicles during the baseline u/s.  Do you have any thoughts or suggestions?  I am afraid that my body cannot handle IVF (nor do we have the money) and I'm wondering what you think our chances are with or without it.  I have read a number of articles on controlled ovarian stimulation but I am not a doctor and the language has been difficult to understand. 

Thank you for your insight,

Mary

Hi Mary

First of all, congratulations on successfully fighting the lymphoma.  It takes a strong will and persistence to get through such a diagnosis. 

Cancer therapy has come a long way in the past few decades.   With people now enjoying long healthy lives following cancer treatment, we are beginning to have to deal with the long term effects of chemotherapy and radiation.   One of these effects is infertility due to diminished ovarian reserve. 

In the future, most patients who are scheduled to undergo chemo or radiation will likely have the option fertility preservation through of freezing eggs or embryos before treatment begins.  Until that time however, we will see many more patients in your situation.

Fortunately, you are still cycling and therefore I believe that you still have some options.  First, I would recommend moving on to a more aggressive treatment than Femara.  Controlled ovarian hyperstimulation (COH) will stimulate production of more eggs than Femara.  This presumably would increase your chances of conception.  While COH does require daily injections and more frequent monitoring than femara, it is less intense and less expensive than IVF.   

At the same time as pursuing COH, I would consider using some alternative methods to bolster your ovarian reserve.  Acupuncture is a safe and relatively easy step which is beneficial in some patients.  I would look to the American Board of Oriental Reproductive Medicine (www.aborm.org) to find a local qualified provider.  Further, there is a low dose androgen called DHEA which likely improves ovarian response.  You can ask your doctor to prescribe it.

Lastly, I would reconsider IVF.  I realize that it is a serious endeavor, but it also represents your best chance at pregnancy.  Considering your FSH level and the fact that women who have undergone chemotherapy tend to enter menopause early, I worry about missing the “window” where IVF can be successful.  If you were to use IVF, I would still recommend using the above alternative methods as well.

I hope this is helpful Mary, good luck, and feel free to contact me with any questions.

Dr. Marc

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