Even egg retrieval can be risky for women with MBC. The process may require delaying treatment, which carries risks. The high hormone levels involved in ovarian stimulation have also been a concern, though there are new techniques to reduce that risk. In addition to needing to remain on treatment continuously and indefinitely, additional complicating factors that women diagnosed with MBC face include difficult ethical questions around becoming a parent while living with a terminal illness (although women with MBC are living longer thanks to ongoing improvements in treatment).
Options for preserving fertility with metastatic breast cancer
New targeted therapies and molecular testing are offering fresh hope for women with MBC. “Our treatments for metastatic breast cancer are improving, and there are more young women living longer and longer in this special kind of breast cancer survivorship,” says medical oncologist Ann H. Partridge, MD, MPH, a professor at Harvard Medical School and the director of Young and Strong, a program at Dana-Farber in Boston for young adults with breast cancer. She says whether someone can delay treatment to retrieve eggs depends on factors like how symptomatic they are, and their type of breast cancer and treatment. While some oncologists might be resistant to discussing the topic, Dr. Partridge thinks all patients deserve a chance to understand their options. “This is a challenging situation associated with medical and psychosocial complexity,” she says. “Young women diagnosed with metastatic breast cancer may be as interested in fertility as young women diagnosed with early-stage disease, and it is incumbent on us as their doctors to help them to make the best possible decisions regarding not only treatment of the cancer, but management of this important life consideration—their future fertility.”
If, like Bond, a woman does opt to freeze eggs (or embryos) before starting cancer treatment, it’s important to explore this option right away, and to understand the risks and challenges associated with it: Delaying cancer treatment to retrieve eggs could potentially allow cancer to spread and there are high costs associated with egg retrieval, storage, and using a gestational carrier (more on that below) that are often not covered by insurance. “The decision to freeze eggs before starting treatment is deeply personal and depends on each patient’s clinical situation,” Dr. Hurwitz says. “Some oncologists have historically been reluctant to delay treatment for an egg freezing cycle, which is an understandable concern. The more current thinking, however, is that family-building is such a significant part of long-term survivorship that a brief, well-managed delay is often worth considering. Fertility centers experienced in oncology cases can move quickly, often getting patients through an egg-retrieval cycle and back to their oncology team before their full staging workup is even complete and their treatment plan in place. For hormone-sensitive cancers, we also use medications called aromatase inhibitors to keep estrogen levels low throughout the process, to reduce the risk of tumors growing.”
