Angelina Jolie announced that she’s had a double mastectomy as a preventative measure, based on the results of the BRAC Analysis test. Ms. Jolie’s decision not only put the BRCA1 gene, and the BRAC Analysis test, in the spotlight; it also opened a dialogue about other forms of preventative surgery.
In fact, Ms. Jolie, who has a strong family history of breast cancer and ovarian cancer, is even considering having her ovaries removed as a preventative measure.
Removing the Ovaries
Removing the ovaries, or an oophorectomy, is not a new procedure in the prevention and treatment of cancer. The ovaries produce estrogen and other female hormones, and certain types of breast cancer are highly reactive to estrogen. In women who have these types of breast cancer, the oophorectomy is often used as a means of slowing down the growth and spread of the cancerous cells.
In women who do not have breast cancer, but have the BRCA1 and BRCA2 mutations, removing the ovaries not only prevents the onset of ovarian cancer, it could prevent the onset of certain types of breast cancer.
The doctor could remove the ovaries and the fallopian tubes—the tubes that carry the eggs to the uterus--but leave the uterus intact. Or, he could remove the uterus, fallopian tubes, and ovaries in what is called a total hysterectomy.
Unfortunately, once you remove your ovaries, you can no longer have children. Not only will you no longer produce eggs, you won’t produce all of the hormones you need to support a pregnancy. If you have already had all the children you want, that might not be an issue; but for a woman, of child-bearing age, who has never had children, removing the ovaries closes that door forever.
Luckily, thanks to advances in egg collection and storage, as well as hormone replacement therapy, a woman who needs to have an oophorectomy could still have children. Her two best options for having children after the oophorectomy are donor eggs and fertility preservation.
Organizations like My Egg Bank act as egg donor agencies and fertility preservation centers.
Egg Donor Agencies
As egg donor agencies, these organizations harvest eggs from healthy donors. The agencies thoroughly screen the donors, including genetic counseling, family health histories, and testing for genetic diseases.
Once the donor clears the screening, the agency then has the donor take a series of medications designed to stimulate egg production, then harvests and freezes the eggs for future use.
The recipient would receive the eggs by applying to the donor agency to become a patient. After the application process, the bank will provide the recipient with basic information about the donor eggs that are available. This information includes genetic and race information about the donor, and even photos of the donor from early childhood.
The photos give the recipient an idea of what the donor, and by extension the child, might look like without compromising the identity of the donor. This way, the recipient can choose a donor who closely resembles herself, so that the child will be more likely to share similar traits with her family.
If the recipient has a uterus, and the hormones necessary to support a pregnancy, she could opt to have the eggs fertilized by her partner and implanted into her own uterus. If she does not have a uterus, or does not have the hormonal support, she would use a surrogate to carry the fetus.
Fertility Preservation Centers
As a fertility preservation center, the agency would collect the eggs from the recipient before she undergoes an oophorectomy. As with the egg donors, the recipient might need to take medication to stimulate egg production. However, if she has a hormone-sensitive breast cancer, the agency may opt to avoid using hormone-based medications and simply collect whatever eggs they can without them.
Chemotherapy and radiation therapy can damage the ovaries. In the case of the preexisting cancer, the agency would also need to harvest the eggs before the patient begins treatment, or as soon as possible after.
Once the agency has harvested the eggs, they freeze the eggs and store them until the recipient is ready to use them.
The cost varies by facility, and depends on a variety of factors. In-vitro fertilization (IVF) with a donor egg could cost as much as $25,000, not including the cost of medications. It could cost as much as $500 per year to store an egg in an egg bank. Some egg storage facilities, like My Egg Bank, require a non-refundable deposit, and offer financing for the remainder of the cost.
If you are faced with the decision to have an oophorectomy, either as a preventative measure or to treat an existing condition--and you want to have children in the future--IVF with donor eggs, and fertility preservation could be well worth the cost.
The above entry is a guest blog entry.