BRCA Gene and Fertility

Will you be able to have children?  Will your children inherit the gene?

Thank you, Angelina Jolie for making your journey the BRCA gene public.

Last week the BRCA gene made its way into our every day water cooler conversations. Now that BRCA has become part of the mainstream media conversation, there are many questions and concerns surrounding the BRCA gene and the affect it has on children. Do I have BRCA? If I test positive for the gene will I still be able to have children? Our Chief, Dr. Avner Hershlag, is dedicated to educating and helping women and men understand the BRCA gene mutation, and wrote this post to clear up any misconceptions you may have regarding the BRCA gene.

The BRCA Gene and Fertility

Many patients are grappling with the new reality presented to them when a BRCA gene mutation is diagnosed. What is BRCA?  Everyone has a BRCA gene.  But a very small change in the gene, called a mutation, (BRCA-1 or BRCA-2) may change the course of your life.  The lifetime chance to develop breast cancer is over 80% and ovarian cancer is over 30%.  There are other cancers that may develop at a higher frequency, such as prostate cancer in BRCA-2 patients.

There’s a lot of talk today in the media about what can be done to prevent breast and ovarian cancer from developing in BRCA positive patients.  Many women choose, like Angelina Jolie, to have a double mastectomy with immediate reconstructive surgery of the breast.  Many plastic surgeons have developed expertise in reconstructing breasts after mastectomy and the results are aesthetically great in most cases.  In addition, women ages 35-40, may choose to remove their ovaries hopefully after completing their family.

Completing their family!  Can that be safely done? What if you’re a young woman diagnosed with breast cancer, and you haven’t started your reproductive life yet?  What if you don’t have cancer but because of your family history you have been tested and found positive for the BRCA gene mutation?

We are now able to help women with the BRCA gene, with or without cancer, take control over their reproductive life. Securing fertility is now possible for BRCA patients, with or without cancer.  If you have been diagnosed with the BRCA gene but don’t have a partner yet who you would like to have children with, or if you are in the midst of pursuing a career and want to defer having children, we can help you achieve these goals even with the presence of the BRCA gene.

For women without a partner, we offer egg freezing.  This requires a short course of treatment with fertility drugs, and eggs are retrieved from your ovaries under anesthesia, in a procedure that lasts no more than 20 minutes on average.   Eggs can be frozen for years, and thawed out when you are ready to have a child, fertilized with your partner’s sperm.  New technologies have allowed for excellence survival of eggs coming out of the “deep freeze,” with good fertilization and pregnancy rates.

For those BRCA patients who have a partner they can undergo a similar procedure but their eggs can be fertilized immediately and frozen as embryos.

Women can therefore secure their fertility before they choose to have their ovaries removed.  Pregnancy can be achieved with frozen eggs or embryos after the ovaries are removed.

But what about the children of patients who carry the BRCA gene mutation?

If you have the BRCA gene mutation, your children whether boys or girls, have a 50% chance to carry the gene.

Through genetic diagnosis of the embryos (PGD-Preimplantation Genetic Diagnosis), we are able to determine which embryos carry the abnormal BRCA gene.  Only BRCA-free embryos will be transferred into your womb, therefore practically guaranteeing that you will not transmit this treacherous gene to your children!  The more patients with the BRCA gene are aware of PGD the less and less women and men will have that gene in generations to come.

The BRCA Gene and Angelina Jolie

For more accurate media coverage on Angelina Jolie and her BRCA journey, please visit the following links. All of these media pieces reached out to Dr. Hershlag to include accurate medical information regarding her course of treatment.

Access Hollywood | Angelina Jolie’s Brace Decision: Stars Show Their Support

E Online | Angelina Double Mastectomy: Natalie Portman’s Doctor Father Praises Actress, Explains BRCA Gene

Egg freezing is becoming increasingly popular for women who are interested in planning for a family in the future, but who currently want to focus on other aspects of their lives. However, the ins and outs of egg freezing are still relatively unknown by most people. For those of you who have ever wondered if egg freezing could be right for your life plan, tune in to the live webinar “Elective Egg Freezing,” hosted by the Center for Human Reproduction’s own Dr. Avner Hershlag.

Starting with the history of egg freezing and how it has gotten to the point it’s at today, Dr. Hershlag will discuss the main reasons people decide to freeze their eggs, which covers infertility in both women and men. He will explain how the egg freezing process actually works and its success rates before talking about special programs, including the donor egg program, that can be used in conjunction with egg freezing. Finally, there will be a question and answer session, which will be led by Dr. Michael Nimaroff.

For more information about this webinar or egg freezing in general, visit our webinar page.

Over twelve percent of women born in the United States will be diagnosed with breast cancer at some point in their lives. However, recent research is paving the way to better understanding this cancer and discovering new ways to deal with it.

In the past 20 years, the BRCA (short for BReast CAncer) mutation in either the BRCA1 or BRCA2 gene has surfaced as a mutation that produces hereditary breast-ovarian cancer in those who have the gene. BRCA-1 & BRCA-2 mutations account for 5-10% of all breast cancers, with most occurring in women in their reproductive years.  Many doctors feel that everyone should be tested for the BRCA gene, both for their own peace of mind as well as to protect their future children.

There’s good news! There are ways to prevent passing these genes onto your future children.  If you have the BRCA gene mutation, or other genetic abnormalities, it’s possible to screen your embryos to determine if they also carry the gene, this process is known as Preimplantation Genetic Diagnosis, or PGD. PGD is done in conjunction with in vitro fertilization (IVF).  You will be stimulated to produce multiple eggs which will be retrieved, and combined with your partner’s sperm. Once the embryos have developed, a single cell is removed from each embryo, taken to a lab and diagnosed to see if it carries the genetic abnormality.  Only healthy embryos are transferred back to your uterus for implantation and pregnancy.

If you have been diagnosed with cancer early action is imperative in preserving your future fertility. There is a small window of time between your diagnosis and treatment, in which it is possible to freeze your eggs so you may use them to become pregnant after you successfully beat your cancer. Talk to your physician to see if this is a viable option for you.  You can also get tested for the BRCA mutation. If you have this gene mutation, there is a significantly higher chance that your children could also develop breast-ovarian cancers.  When you survive your cancer and are ready for motherhood, you can have PGD done on your embryos to ensure only those embryos without the BRCA mutation are transferred, thereby allowing your children to grow up without the worry of developing cancer related to this treacherous gene.

The National Cancer Institute has very helpful information on the BRCA1 & 2 mutations, including a quick guide to help you assess whether the BRCA is screening is right for you:  http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA.

For more information, you can always contact our office coordinator at 516-562-2229.

April 21 – 27 marks an awareness week that many people don’t know about: National Infertility Awareness Week (NIAW). During this week, the National Infertility Association sponsors events to raise awareness and advocacy about infertility.

The movement toward a week dedicated to talking about infertility began back in 1989, but it was not until 2010 that NIAW became fully recognized by the Department of Health and Human Services. Today, its main goals are to enhance the public’s understanding of infertility, and to educate legislators about infertility’s impact.

If you’re planning to have children in the future it’s always a good idea to talk to your doctor about infertility testing. Sometimes infertility is simply a matter of missing the right days of ovulation. If, however, you have tried timing conception with peak ovulation and have had no success, it may be time to have a fertility specialist conduct fertility tests. These may involve physical exams, semen analysis, blood tests, or other procedures.

For more information or to see if there are any NIAW events happening in your area, visit www.resolve.org. Do not let uncertainty about your fertility stop you from having the family you have always wanted.

Women today have more options than ever before when it comes to taking control of their life. The same is said for when to have children. Egg freezing—the removal, freezing, and storage of a woman’s eggs—is a way for a woman to plan for her future without sacrificing her goals of the present. Here are just a few of the reasons you should consider egg freezing:

1. Your Biological Clock is Always Ticking

While exercise, monitoring what you eat, and looking years younger than your actual age are all great, there’s no denying the fact that as you get older your biological clock is still ticking away. Today, over 20 percent of women are over the age of 35 before they have their first child. This doesn’t sound disconcerting, until you find out that one-third of couples in which the female partner is over the age of 35 experience fertility issues. Waiting longer to have children is glamorized in the media and corporate world, with stories of women in their mid-40s getting support for waiting to conceive. However, given today’s statistics about age and fertility, it’s likely many of these women have used a donor, surrogate, or egg freezing procedures and chosen not to share those details. Ultimately, age is one the most important factors to consider in regard to fertility, since you cannot turn your biological clock back.

2. Technology is a Gift You Shouldn’t Be Afraid Of

Many of the technological advances we have today seemed frightening in the beginning: the car, the airplane, the computer. All these advances eventually broadened our horizons of how we view the world and gave us more options for how to live life, but they took some getting used to. Freezing eggs is another one of those technologies. Conceiving the “old fashion way” is not always a possibility, thankfully technology allows an alternative route to achieving your dream.

3. Advanced Techniques Make Success Rates Better Than Ever

The first documented birth using a frozen egg happened back in 1986. Since then, egg freezing techniques have come a long way. Eggs are delicate and sometimes difficult to freeze; since they are made up mostly of water, ice crystals can form when the eggs are frozen, which are detrimental to the eggs being useable later on. However, a newer, flash-freezing process of freezing eggs has been developed, called vitrification. The American Society for Reproductive Medicine (ASRM) has lifted the experimental label from egg freezing because of these technological advancements. This process is associated with better development and higher survival rates compared to the slow-cooling method of freezing eggs. The best thing to do is to see your doctor and talk about freezing your eggs at as young an age as possible, to have the healthiest eggs and best chance at a successful pregnancy.

4. Time is of the Essence! Preparation is the Key to Success

Modern women have learned that if they have goals, they are going to have to work hard to accomplish them; their life will not fall into place on its own. They attend prestigious universities for years and spend thousands of dollars in the hopes that they can use that time and education to jumpstart them in their career. Why would we not treat having a family in the same way? Freezing your eggs is like putting money in the bank for retirement—it’s preparation for a future you’d someday like to have. You may not have found your Mr. Right, but your biological clock is still ticking. Freezing your eggs gives you the opportunity to continue with your life and your goals without the pressure of settling down and having a family.

5. Fertility May Decline, but Your Ability to Get Pregnant May Be Protected, if You Act While You’re Young

Infertility is defined in many ways, but generally, if you have been having regular sexual intercourse with no contraception for a year and are not pregnant, you may be infertile.  Many couples in their 30s think that because they have been trying to get pregnant for months with no success, this means they are infertile. However, age and fertility are highly correlated. By age 35, the ability to conceive naturally goes down drastically with each year. It’s possible that you are past your prime years to conceive naturally, but can still becoming pregnant through the use of reproductive technology. It is for this reason that it is beneficial to freeze your eggs at a young age.

Deciding to freeze your eggs is not a decision that women make lightly.  We’re happy to speak with you about the process and whether it’s a good fit for you.  Contact the Center for Human Reproduction to speak with a fertility specialist.

The American Academy of Pediatrics (AAP) has recently published a statement saying that they support children being raised in any type of positive two-parent household, whether the parents are heterosexual, gay or lesbian, or of another orientation. The goal of the AAP is for children to have the most optimal and nurturing environment possible. They feel this can be achieved whether children are parented by married couples, nonmarried couples, relatives, or legal guardians, those of which may have any sexual orientation

There are several options for gay or lesbian couples who would like to have children. Adoption is one way, but medical technology has made it possible for same sex couples to have children that are biologically related to one of the partners. A gay couple can use a gestational carrier, also known as a surrogate, along with a donor egg to have a child. A lesbian couple can use donor sperm and one of the partners can carry the child. These options allow couples to experience pregnancy and a biological link to their children.

For more information on surrogacy, egg or sperm donation, or other same sex fertility options, contact The Center for Human Reproduction for a personalized consultation.

In a recent article entitled “Ectopic Pregnancy Treatments Have Similar Effects on Fertility,” the results of a two-year study following women who had undergone treatment for ectopic pregnancies were published. Over 400 women in France who had an ectopic pregnancy were treated using one of three methods: a methotrexate injection which halted the pregnancy; conservative surgery, which preserved the fallopian tube; and radical surgery, which removed the fallopian tube. One part of the study compared those who received drug treatment to those who received conservative surgery. The other part of the study compared the conservative surgery to the radical surgery.

Two years after treatment, the pregnancy rates following each treatment were fairly comparable: 67 percent for those who underwent drug treatment, 70 percent for conservative surgery, and 64 percent for radical surgery.

Dr. Hershlag, chief of the Center of Human Reproduction located at North Shore University Hospital, was mentioned in this article and said these reportings “reaffirm our experience that [nonsurgical] medical treatment is sufficient in most cases of ectopic pregnancy,” if the ectopic condition is discovered early enough.

This is good news for women who have undergone treatment for ectopic pregnancies, giving them hope that a normal pregnancy is still possible even after such treatment.

To learn more about fertility treatment or assistance for those who have experienced ectopic pregnancy, contact  The Center for Human Reproduction at 516-562-2229.

More women than ever are choosing to wait to have children. However, their biological clocks are still ticking on as normal, causing many women to grow concerned over their ability to have children later in life. A woman’s egg reserve drop from 6 million eggs in fetal life, to 300,000 at puberty to zero at menopause—egg freezing allows women reproductive freedom, which in the past was only available to men who can reproduce throughout their lives.   Egg freezing has become increasingly popular as it allows women to preserve their eggs during their fertile years when their eggs are plentiful and healthy.

Surprisingly, freezing eggs is not a new or recently developed procedure. The first documented birth from using a frozen egg occurred more than 20 years ago.Since that time new research and better methods have made egg freezing more popular and more successful, resulting in an increase of pregnancies from frozen eggs.

October 22, 2012 marks a milestone in egg freezing. The American Society for Reproductive Medicine (ASRM) removed the “experimental” label from egg freezing following extensive research proving the efficacy and safety of egg freezing. ASRM officially lifted the experimental label, meaning hundreds of women and couples will pursue egg freezing with fewer reservations.

Freezing your eggs is a way of taking “reproductive insurance,” helping to increase your chances of conception at a later date.  Unlike the decision to have children you do not have to enter into egg freezing with a partner, a large 401k, or a daycare plan!  However, it is recommended that you be in your late twenties to mid-thirties as the benefits of egg freezing decline with age.

Ultimately, it is important to talk to your physician and find out if this is the right path for you. For more information on egg freezing, contact our patient coordinator at 516-562-2229.

Start spreading the news Manhattan residents now have access to a cutting-edge fertility center with the opening of the Lenox Hill Human Reproduction.

The highly-qualified staff are led by Dr. Tomer Singer, the first full-time reproductive endocrinologist at Lenox Hill Hospital, in providing the best care possible for their clients. Dr. Singer and Lenox Hill Human Reproduction are affiliated with North Shore-LIJ Health System’s Center for Human Reproduction and Lenox Hill Hospital. The Center for Human Reproduction has assisted in bringing over 25,000 babies into this world since the center started in 1976. With convenient locations in Queens, Suffolk, Nassau counties, and now Manhattan, Lenox Hill is honored to bring fertility care to patients in their own neighborhoods.

Traditional assisted reproductive technologies like IVF and IUI are offered at Lenox Hill Human Reproduction, as well as more innovative services such as fertility preservation/egg freezing, PGD/PGS for screening of embryos for genetic disease and chromosomal abnormalities and a donor egg bank for affordable donor cycles. The center makes every effort to bring excellent care in a warm, convenient environment to support patients in building a family.

For more information about Lenox Hill Human Reproduction or the services offered, or to schedule an appointment with Dr. Singer, call (212) 324-BABY (2229) or visit lenoxhillhumanreproduction.com.

Sofia Vergara revealed to Vogue Magazine that she is freezing her eggs. The actress, 40, has one son from a previous marriage, and is engaged to fiancé Nick Loeb, 37. Loeb doesn’t have children, which factored into Vergara’s decision to pursue egg freezing.

Experts highly recommend Egg Freezing as a way to preserve fertility. “Ms. Vergara’s choice to freeze her eggs is one I strongly support. I make it a point to educate my patients on the many benefits of egg freezing, ” said Dr. Tomer Singer, a Reproductive Endocrinologist at Lenox Hill Human Reproduction. “When considering fertility options, it is important to take into consideration the quality and quantity of eggs that can be harvested at a given age. Whether for the purposes of career or other reasons such as cancer or a family history of early menopause, egg freezing at an early age provides a woman the option of postponing childbearing until she is ready.  For those considering fertility preservation, having a frozen store of eggs provides a woman with a sense of security and promise.”

Vergara is one of thousands of women worldwide who are choosing to freeze their eggs to help reduce the pressure of their biological clock. Whether women are in Vergara’s situation, or have different reasons for considering egg freezing, such as plans to pursue their career before starting a family, or for medical reasons, egg freezing is an effective way to plan for the future. Frozen eggs are suspended in time, ready to be thawed, fertilized, and placed into the uterus where ideally a pregnancy will develop. By freezing their eggs, women are able to focus on the present without the stress and worry an uncertain future can bring.

To find out more about freezing your eggs, contact a fertility specialist at the Center for Human Reproduction.