Download 66 Fig. 5.2 Treatment guidelines for fertility preservation in young

66
N.C. Llarena and J.S. Jeruss
Reproductive age
patient at high risk
for breast or ovarian
cancer
Delay tamoxifen
therapy to attempt
pregnancy.
Pregnancy
may be natural
or via ART.
Consultation with
oncologist to
discuss role of
preventive
therapies in
risk reduction
Tamoxifen
indicated for
breast cancer
chemoprevention
Discuss potential
impact of
preventive
therapies on
reproductive
health
Preventive
treatment plan
involves
temporary or Text
permanent
threat to fertility
Initiate tamoxifen
therapy, interrupt
therapy to attempt
pregnancy, and
resume to
complete 5-10
years of therapy.
Pregnancy may
be natural or via
ART.
If patient is
interested in
future childbearing,
discuss options
for sequencing
preventive treatment
and pregnancy
Patient interested
in fertility
preservation;
referral to fertility
specialist
Patient has a
BRCA1 or BRCA2
mutation;
oophorectomy is
indicated
Assess baseline
ovarian reserve
(FSH, AMH, inhibin B)
Diminished
ovarian reserve
Use of donor
egg and IVF
Use of gestational
surrogate or
adoption
Normal
ovarian reserve
Natural pregnancy
prior to
preventive
treatment.
If patient receives
tamoxifen, natural
pregnancy may
be attempted
during an
interruption in
therapy or after
completion of
treatment.
Complete 5-10
years of tamoxifen
therapy prior to
attempting
pregnancy.
Pregnancy may be
natural or via ART.
Delay
oophroectomy
to allow for
pregnancy.
Pregnancy may be
natural or via
ART. Role of PGD
may be discussed.
If uterus
remains intact,
pregnancy after
oophorectomy
is possible using
cyropreserved
embryos or eggs,
or donor eggs.
Role of PGD
may be discussed.
Hormonal
stimulation and
embryo or egg
cryopreservation
prior to preventive
treatment. If patient
receives tamoxifen,
IVF may be
attempted during
an interruption in
therapy or after
completion of
treatment.
Fig. 5.2 Treatment guidelines for fertility preservation in young women at high risk for breast
or ovarian cancer. A discussion about fertility as it pertains to preventive cancer treatment is an
integral part of care for young patients at increased risk of breast and ovarian cancer. Referral to a
T.K. Woodruff et al. (eds.), Oncofertility Communication: Sharing Information and Building Relationships across Disciplines,
DOI 10.1007/978-1-4614-8235-2_5,
© Springer Science+Business Media New York 2014