I’m a 28 year old single woman who was recently told that I carry the BRCA1 gene mutation. Apparently my mother inherited the mutation from her father. I would dearly love to have children in the future, when I find the right partner and have a stable job. But I’m concerned about my high risk of breast and ovarian cancer. As I make decisions about preventive treatment, what should I be considering in terms of my future fertility?

Written by our medical expert Dr. Beth Taylor, co-founder and co-director of Olive Fertility Centre, Vancouver, British Columbia. 

As you know, carrying the BRCA1 gene gives you a high risk of developing breast and ovarian cancer over the course of your lifetime.  While women without this mutation have about a 10% chance of developing breast cancer and a 1% chance of ovarian cancer, your risk is closer to 60% for these cancers.  As a result many women consider removing their breasts and ovaries to reduce their risk.  Removing your ovaries would prevent you from having children with your own eggs, so exploring your options before deciding on surgery is a good idea.

Your options are:

1. Egg freezing – this process involves taking hormone injections for about two weeks and then having some of your eggs removed and frozen in a lab until you are ready to be pregnant in the future.  So, if you remove your ovaries you will still have a chance of conceiving with your own eggs in the future.  When you are ready we would thaw the eggs, fertilize them with sperm and create embryos.  The embryos would be put into your uterus to achieve a pregnancy.  The success of egg freezing depends on your age, how many eggs you have and how many eggs we can harvest. You are young so your chances of having a baby from frozen eggs is quite high.  Egg freezing costs about $10,000, including medications.

2. Conceiving now using donor sperm, as a single parent – you can use donor sperm from someone you know or from an anonymous sperm donor through a sperm bank.

3. Remove your ovaries now and use donor eggs in the future – you can get eggs from someone you know (e.g. a sister) or from an anonymous egg bank in the future when you have met someone you want to have children with.

4. Wait and see – hold off on surgery to see if you meet someone to have children with.  This should only be done after discussing your risks with your oncologist.

You might be wondering if there is any way of preventing your children from inheriting the BRCA1 gene, like you did.  There is, it’s called preimplantation genetic diagnosis (PGD). In this treatment your eggs are harvested, fertilized with sperm and embryos are created.  The embryos are then tested to see which ones have the BRCA1 gene, and only those embryos that do not have the gene are put into your uterus to achieve a pregnancy.

The good news is you have options.  Your age is also a good thing: the younger you are when conceiving or freezing eggs the more successful you’ll be and the fewer complications pregnancy might bring.

Good luck and speak with a fertility physician if you want to explore your options for being pregnant now, or preserving your eggs for the future.

Read about two women’s stories of making choices around fertility and preventative treatment here and here. 

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