This sounds kind of odd. Why would fertility specialists use a drug intended to treat breast cancer patients to help couples conceive? To those in the field, the concept is nothing new. Clomiphene (Clomid) is a close relative of Tamoxifen, a drug used for years to prevent the recurrence of breast cancer. These drugs which block the action of the female hormone estrogen, cause hormone fluctuations that stimulate eggs to grow. Over the past decade, doctors have begun to use another breast cancer drug called Femara or Letrozole to treat couples in with infertility. Like tamoxifen, letrozole is used to prevent recurrence in breast cancer patients, and like clomiphene, it can also be used to stimulate ovulation (release of an egg). Until now, clomid has been the gold standard to help make women ovulate since it is relatively inexpensive and safe. Recently, however, a large study was published suggesting that letrazole may actually be more effective than clomiphene and result in fewer multiple births. Over time, it is likely that letrazole may replace clomiphene as a first line fertility drug.
One of the most common questions patients ask us when they are about to start fertility drugs, is are they are safe? This question comes up whether they are going to start pills (Clomid, Femara) or injectable fertility drugs (Follistim, Gonal-F, Bravelle, Menopur). Unfortunately, the answers are not always so clear cut as we would like. One of the major concerns women have is about cancer, and the cancer which more women seem to fear than any other is breast cancer. In the past there have been questions about whether fertility drugs increase the risk of breast cancer. A recent study may help to reassure anxious couples. The researchers followed fertility patients from multiple institutions and showed that women treated with fertility drugs, both oral and injectables had the same rates of breast cancer as those who were not. The only exception was women with who took clomid for over year, who did have a slightly higher rate of breast cancer, another good reason to be proactive and see a fertility specialist early on.
The use of Preimplantation Genetic Testing (PGD) enables fertility doctors to screen embryos for genetic diseases such as Cystic Fibrosis or Sickle Cell Anemia, permitting couples at high risk to avoid transmitting these diseases onto their children. PGD is done as part of an IVF cycle. A biopsy is taken when the embryo reaches the 8 cell or the blastocyst stage, and tested for the specific gene we are concerned about. This same technology can also be used to test for genes that do not necessarily cause a disease but put an individual at risk for other serious diseases. One such genetic mutation, called the BRCA 1 and 2 gene, puts affected women at very high risk for developing breast and ovarian cancer. The risk of developing these cancers in affected women is so high that many women (such as Angelina Jolie) chose to have their breasts and/or ovaries surgically removed just to prevent cancer. Since we know the genetic sequence of the BRCA mutation, it is possible to screen embryos for it, and prevent transmitting the gene onto one's daughters. This article in the Wall Street Journal tells the story of a family who decided to go that route.
Most survivors of childhood cancers (and their physicians) assume that they will be unable to have children should they make it to adulthood. It turns out that may not always be the case. A recent study in the British journal Lancet suggests that women going through fertility treatment may actually have a reasonably good chance to conceive using fertility treatment. Still, for most, it is an uphill battle. More information on fertility after cancer is available at Fertile Hope
Assisted reproduction and particularly advances in fertility preservation procedures such as egg freezing has made it more likely than ever that men and women will have offspring born after they are deceased. A woman who freezes her eggs (or a husband his sperm) before chemotherapy may not survive the cancer. So what happens when those eggs or sperm are used to help the surviving partner or some one else conceive? This article in the NY Times explores the legal and financial issues that might arise.