BRCA and Your Fertility

Thank you, Angelina Jolie, for making your experience dealing with the BRCA gene public.

Everyone has the BRCA gene. But a very small change in the gene, called a mutation (BRCA1 or BRCA2),  can increase the lifetime risk of developing breast cancer more than 80 percent and ovarian cancer more than 30 percent. Other cancers may develop at a higher frequency in BRCA2 patients, such as prostate cancer.

There’s a lot of discussion about what can be done to prevent breast and ovarian cancer from developing in patients with a BRCA mutation. Like Ms. Jolie, many women choose to have a double mastectomy with immediate reconstructive surgery of the breast. In addition, some women between 35 and 40 choose to remove their ovaries after completing their family.

Completing their family–can that be done safely? What if you’re a young woman diagnosed with breast cancer, and haven’t started your reproductive life yet? What if you don’t have cancer but a DNA test reveals you have a BRCA mutation?

Fertility Options for BRCA-Positive Patients

Physicians who specialize in fertility can help BRCA-positive women to take control of their reproductive life–with or without cancer.

For instance, BRCA-positive women without a partner can freeze their eggs. This requires a short course of treatment with fertility drugs, and retrieval of the eggs under anesthesia in a procedure that takes about 20 minutes. Eggs can stay frozen for years, then thawed and fertilized when a woman is ready to have a child. New technologies allow excellent survival of eggs coming out of the “deep freeze,” with good fertilization and pregnancy rates.

BRCA-positive women who have a partner can undergo a similar procedure, only their eggs are fertilized immediately and frozen as embryos.

Children of patients who carry the BRCA mutation have a 50 percent chance of inheriting it. Through preimplantation genetic diagnosis (PGD), physicians can determine which embryos carry an abnormal BRCA gene and only implant embryos without the mutation into the womb that. This practically guarantees the genetic abnormality will not transmit to the child. The more BRCA-positive patients know about preimplantation genetic diagnosis, the fewer women and men will carry that gene in the future.

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