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Melanoma-What Every Woman Need to Know about Fertility and Pregnancy

Women diagnosed with melanoma may require counseling for fertility preservation, fertility treatment and safety of pregnancy after treatment. Melanoma is one of the most common cancers in young adults in the United States. In the US and worldwide, there is  dramatic increase in the incidence  of skin melanomas. Approximately 30,000 women are expected to be diagnosed with melanoma in 2010, one third will be in their reproductive years. Its the most common cancer in young adults 25 to 29 year old. Its more common in white women compared to African Americans and Hispanics.  Approximately  10% of melanomas run in families or are genetically inherited. Treatment of melanoma requires surgery. In advanced melanoma, chemotherapy is added. Dacarbazine-DTIC is an alkylating agent used for treating melanomas. Immune therapy is also used for advanced melanomas- interferon α or IL-2.

In early stages, surgery is the only required treatment. In advanced stages if chemotherapy is used, ovarian reserve may be diminished and this may reduce woman’s ability to get pregnant. The use of immune therapy is not known to affect future fertility. The effects of newer targeted therapies and vaccines on fertility are also unknown.

Melanoma and fertility treatment. The estrogen receptors were found on melanoma cells. Some researchers detected no significant increase in the risk of melanoma after treatment with fertility drugs, except possibly slight increase in risk in women who delivered children before. The relationship between estrogen exposure and melanoma is controversial. Women seeking fertility preservation before exposure to chemotherapy or melanoma survivors desiring pregnancy after completing treatment should consult with a fertility preservation specialist about the risks and benefits of fertility treatment and the safety of pregnancy. The ovarian stimulation regimen can also be modified to minimize estrogen exposure. It may also be possible for women with inherited predisposition to melanoma to avoid transmission to future children through testing of embryos-PGD.

Melanoma and pregnancy. Ten studies including 5600 women found that pregnancy does not reduce survival in women diagnosed with melanoma. Women treated for melanoma who subsequently became pregnant were not adversely affected compared to women who did not get pregnant after treatment. For thin tumors-<1.5mm most experts do not recommend deferring pregnancy. For thicker tumors, physicians may recommend deferring pregnancy for two years as most recurrences take place during that interval. Read more at http://nycivf.org

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What Can you Accomplish through IVF ?

What Can you Accomplish through IVF ?

Defining your reproductive goals early on before starting  is essential in guiding the choice of treatment. IVF is the most versatile and robust fertility treatment available. In addition, it accomplish many reproductive goals that are no achievable with IUI.

What Can you Accomplish through IVF ?

Getting pregnant now

IVF can be performed in almost all causes of infertility:

Ovarian factor, male factor, tubal factor, emndometriosis, polycystic ovary syndrome (PCOS) and uterine factor. Success does not appear to be affected by the cause of infertility with the exception of diminished ovarian reserve. Hence, it is important that you seek evaluation as early as you can.

The ovary is stimulated using fertility medication. Various protocols of treatment are tweaked to your special situation and to maximize egg production. Sometimes mild or minimal stimulation IVF is a more suitable approach. Eggs are retrieved and fertilized in the lab using husband or donor sperm.

Embryos are graded based on morphology (shape) and an appropriate number is transferred into the uterine cavity. In the majority of men, sperm is obtained from the ejaculated sperm. In some surgical sperm retrieval (TESE) is required.

Getting pregnant with a single baby

Conceiving with a single baby should be the aim of every woman. The risk of twins and high order multiple pregnancy is high risk of preterm delivery. Premature delivery can lead to long term health problems in the babies. Unlike IUI where the number of embryos reaching the uterine cavity cannot be controlled, IVF allows for a strict control on the number of embryos reaching the uterus. Women with reasonable quality embryos up to age 38 or so can consider the transfer of a single embryo and freezing the other embryos.

In that regards IVF is the more conservative approach when compared to IUI, besides being several folds more successful in achieving a pregnancy.

Getting pregnant in the future with a current partner

Embryos created now after IVF, can be frozen for several years. When desired, frozen embryos are thawed and transferred into the uterus in a natural or hormone treated uterus. This allow you to extend your fertility for years to come. The survival of frozen embryos is excellent, especially using moder freezing methods (vitrification).

The pregnancy rate after transfer of frozen embryos is comparable to fresh embryos. There is also some evidence that pregnancies ensuing after transfer of thawed embryos are at lower risk for obstetrical problems.

Getting pregnant in the future with a future partner

If you do not have a male partner and do not want to use donor sperm, you can consider freezing your eggs. Because your ovarian reserve; the number and quality of eggs; will diminish as the time goes by, freezing eggs at an earlier age, enables you to freeze healthier eggs and use them years later when you are ready. Egg freezing is a fertility solution for fertile women.

Selecting the Sex of the Baby (Family Balancing)

Eggs are retrieved, fertilized. The resulting embryos are tested; one cell is obtained from each embryo and tested for the X and Y chromosomes to identify the genetic sex. The desired embryos are transferred into the uterus . Women consider sex selection for family balancing (had a baby of one sex and desire another baby of the other sex). Women consider sex selection when they want to reach their reproductive goals e.g one boy and one girl, while limiting the number of children conceived.

Getting Pregnant with Donor Eggs

For women with markedly diminished egg reserve or some genetic abnormalities, using an egg donor is an option. Egg donor may be known or anonymous. The donor is stimulated and fertilized with partner or donor sperm then the embryos are transferred to the uterus of the mother or a gestational carrier.

Becoming a Biological Parent without Getting Pregnant

Some women are not able to get pregnant in their own uteri because of a condition affecting the uterus: scarring, multiple fibroids, adenomyosis, recurrent preterm delivery..Others prefer not to get pregnant because of a general health problem: successful treatment of breast cancer, severe hypertension or heart disease. Embryos are created through IVF and transferred to the uterus of a gestational carrier (surrogate mother).

Genetically Test the embryos before getting pregnant

Embryos created after IVF can be tested genetically for i. A specific gene or ii all the chromosmes. This is accomplished through two steps. Biopsy of the embryos (one cell in day 3 embryos or few cells from the trophoectoderm of day 5 embryos – blastocysts). The cells are tested for the desired genetic target and the healthy embryos are transferred to the uterus.

Becoming a Biological Father if you are in a Same Sex Relationship

Men in a same sex relationship can father children using an egg donor and a gestational carrier. The donor ovaries are stimulated. Eggs are retrieved and fertilized  with one partner sperm or split between partners. Embryos are then transferred into the uterus of a gestational carrier.

Preserve your Fertility in the face of a medical Problem

Sometimes a a medical problem or its treatment reduces the chance for future reproduction. Breast cancer treatment in young women commonly involve treatment with chemotherapy. Medical problems other than cancer also may require treatment with chemotherapy e.g systemic lupus. Chemotherapy leads to loss of ovarian follicles and diminish egg reserve.

The ovaries are stimulated prior to exposure to chemotherapy. Oocytes are retrieved and frozen unfertilized or after fertilization. After treatment, eggs or embryos can be thawed and used for reproduction.

How Successful is IVF ?

Irrespective of the situation, the most important factor in IVF success is the number and quality of eggs remaining in the ovary (Ovarian reserve). Maternal age is the most important determinant of egg reserve. Younger women have more chromosomally normal eggs and are more likely to have a baby after IVF.

In women younger than 35, the transfer of two embryos yields a pregnancy rate of 48 to 50% and one embryo 35 to 40%. In women 40 or older the pregnancy rate per cycle is approximately 5 to 20%  depending on age. Many cycles in older women are not completed due to low response to fertility medications.

Modern IVF enables many women and men to achieve there reproductive goals and conform to their social and personal preferences and aspirations.

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