July 20, 2011 -- Carly Byrd's worst fear isn't dying from the cancer that has claimed both her breasts and invaded her immune system; it's that the treatment she needs to live might crush her dreams of having children.
Byrd is still battling for her life four years after she was first diagnosed with breast cancer at age 25. Despite multiple lumpectomies, a double mastectomy and radiation therapy, she now needs aggressive chemotherapy -- a cocktail of toxic drugs that causes her to lose her hair and appetite, and could rob her of her fertility, too.
"My oncologist told me there was a 30 percent chance that the chemo I had to have would toss me into early menopause," said Byrd, who said she has dreamed of being a mom her whole life. "When cancer and the procedures to treat it start taking real things away from you, it's a big pill to swallow."
Roughly 12 percent of breast cancer patients are under 45, but the chemotherapy they need to beat their illness can push them into early menopause. Cryopreservation, a procedure that freezes and stores eggs, embryos or ovaries until the cancer is gone, can help patients put motherhood on ice. However, it takes time, money and forethought -- all of which may be in short supply for women fighting for their lives.
But a new drug that suppresses ovarian function could help breast cancer patients preserve their fertility without delaying chemotherapy or breaking the bank, according to an Italian study. Patients who took triptorelin, an injectable gonadotropin releasing hormone (GnRH) analogue, one week before chemo and every four weeks throughout their treatment were 17 percent less likely to experience early menopause than patients who did not. The results were published Tuesday in the Journal of the American Medical Association.
"In comparison with cryopreservation strategies, GnRH analogue-induced ovarian suppression has the advantages that it does not require a male partner, is simple to administer, does not require delaying chemotherapy, and is less invasive and less expensive," Dr. Lucia Del Mastro, an oncologist at the National Institute for Cancer Research in Genoa, Italy, and colleagues wrote in their report.
The rate of early menopause was 8.9 percent in patients who took triptorelin, compared to 25.9 percent in patients who did not. The study authors, and authors of an accompanying editorial, suggest the drug could broaden the options for breast cancer patients who hope to have children.
For Byrd, who jumped through hoops to freeze 25 of her eggs a week before starting chemo, the option to preserve her fertility was empowering.
"I think that it just makes me the victor over cancer," she said. "It makes me feel very proud and very strong to cheat cancer out of preventing me from one of life's journeys. It's like, 'You can't take that, because I made sure of it.'"
Byrd traveled from her home in LaGrange, Ga., to the Sher Institute for Reproductive Medicine in Dallas for the procedure in order to fit it in before chemo, which meant ringing in her 29th birthday with multiple injections of hormone-disrupting, egg-harvesting drugs.
"That was not much fun," she said. But Byrd's mom, who moved from North Carolina to Columbus to take care of her, said, "At least you're spending your birthday with your future children."
Freezing Eggs to Preserve Fertility: Cold Comfort for Cancer Patients
A breast cancer diagnosis is devastating at any age. But for Byrd, who was a healthy college grad with no family history of cancer, it was downright shocking. The worst part, she said, was the anticipation of what might happen.
"If I had to add the anxiety of losing my fertility, it would have been unbearable," she said, describing the relief that came with freezing her eggs. "Even if I don't have to use them, just knowing they're there gives me so much solace and peace of mind."
Byrd is facing another year of chemotherapy. But she said she looks forward to getting her life back on track as she enters her 30s.
"I'm very excited about normalcy," she said, adding that she hasn't been able to work or date since she started her treatment.
"People ask me, 'Why don't you date?' Do you want me to date my radiologist or the guy who sold me my wig?" she said, explaining how her life has been taken over by tests and treatments. "I haven't had time to get back to how I am, because cancer keeps attacking me."
But when she conquers breast cancer for good, Byrd looks forward to meeting the father of her future kids.
"I think it will mean that much more," she said. "When I meet the man I'm supposed to be married to, he will love me that much more for giving us this opportunity."