Risk Management
fertility and parenting
Fertility issues
Very little has been written on the safety of fertility medication and in-vitro fertilization in people with a BRCA mutation or hereditary cancer risk. At our 2007 annual conference, in his session on "External and Environmental Modifiers of Cancer Risk" Dr. Steven Narod presented on the effects of different fertility medications on cancer risk in BRCA carriers. You can view a free webcast from the session.
In-vitro Fertilization and Preimplantation genetic diagnosis
Preimplantation Genetic Diagnosis (PGD) is a medical procedure that allows people who carry a disease-causing hereditary mutation to have children who are free from the specific mutation that causes the disease.
The procedure for PGD includes in-vitro fertilization (IVF)—a fertility treatment where the women’s eggs are removed and fertilized in a test tube. When the embryos reach a certain size, one cell is removed and is tested for the hereditary disease in question. Once the genetic status is determined, the parents can decide which embryos they want implanted.
PGD has been used for hereditary diseases such as cystic fibrosis and Huntington’s disease for over a decade. Recently, there has been some debate among the medical community regarding its use for selecting embryos free of gene mutations such as BRCA1/2. Central to this debate is the issue of whether or not this procedure should be used for mutations such as BRCA which don’t cause cancer until adulthood, where not everyone who carries the trait will get cancer, and where there are options available for preventing cancer (such as chemoprevention and surgery).
Researchers from Moffitt Cancer Center in Tampa teamed up with FORCE to survey FORCE members about their knowledge of and attitudes about PGD. Results from the survey are reported in an article published in the Journal Fertility and Sterility. The Spring 2008 edition of Joining FORCEs, the FORCE newsletter has an article that summarizes the study and it's results.[Back to Top]
Adoption
Whether you are a cancer survivor or previvor, adoption is a wonderful way to create or expand a family. There are many reputable professionals, agencies and organizations available for education and support. The Summer/Fall edition of Joining FORCEs has two articles related to adoption. "Courtney's Adoption Story" tells one members journey through adoption after breast cancer. The accompanying commentary has information on types of adoption and adoption resources.
Other websites
American Academy of Adoption Attorneys
This organization represents attorneys who practice, or have otherwise distinguished themselves, in the field of adoption law. The site contains a searchable database for finding adoption attorneys in your area.
Discussion of Challenges, Concerns, and Preliminary Policy Options Related to the Genetic Testing of Human Embryos
Published by the Genetics and Public Policy Center, this article presents the difficult and complex issues associated with Pre-implantation Genetic Diagnosis in a balanced and easy-to-read format.
Fertile Hope
Fertile hope is a nonprofit organization providing information and support for cancer patients whose medical treatments may affect their fertility. The website provides a wide range of information as well as links to organizations, selected health care providers, and other resources.
National Adoption Information Clearinghouse
This website c ontains links to regional and national resources and articles on adoption.
Reproductive Health Technologies Project
The mission of this project is to advance the ability of every woman to achieve full reproductive freedom with access to the safest, most effective, and preferred methods for controlling her fertility and protecting her health. Contains easy to understand article on Pre-implantation Genetic Diagnosis (PGD).
Further reading - articles (advanced reading)
Attitudes of high-risk women toward preimplantation genetic diagnosis
Gwendolyn Quinn, Ph.D., Susan Vadaparampil, Ph.D., M.P.H., Crystal Wilson, B.S., Lindsey King, M.P.H., Jimin Choi, Ph.D., Cheryl Miree, M.S., Sue Friedman, D.V.M. Fertility and Sterility, (In Press).
Views of BRCA gene mutation carriers on preimplantation genetic diagnosis as a reproductive option for hereditary breast and ovarian cancer
Usha Menon. Human Reproduction, 2007; Vol. 22, No. 6: pages 1573-1577.
Cancer Genetic Testing and Assisted Reproduction
Kenneth Offit, Kelly Kohut, Bartholt Clagett, Eve A. Wadsworth, Kelly J. Lafaro, Shelly Cummings, Melody White, Michal Sagi, Donna Bernstein, Jessica G. Davis. Journal of Clinical Oncology, 2006; Vol . 24, No. 29; pages 4775-4782.