QuestionHello from Houston, texas.
Would like your opinion of my chances of getting pregnant and hysterectomy.
I will be 41 in September, white female. Medical issues: diagnosed with Non-hodgkins b cell lymphoma in 2006. Radiation in 2006 on chest area - successful. Cancer found in stomach: ritoximum chemo in 2007, didn't work. 6 rounds of full R-CHOP in 2008 - successful and in remission as of 11/08. Laparoscopy surgery for endometriosis in 1989 and 1997. currently have two 1.5cm cysts on ovaries. severe cramping 24/7 for over two years. Active Sjogren's Syndrome. Positive antibody for Lupus and Rheumatoid but not active. Severe gastroparesis, Celiac Disease, Fibromyalgia. Off birth control since 1994 but did take it while doing chemo last year (did not help cramps). Zero pregnancies and never been pregnant. In the 1990's I took fertility pills but never any injections.
My GYN is recommending a full hysterectomy and I am in agreement, but there is that small part of me that still wants to have a baby. With my infertility history, my age, my chemo (which included the drug Cyclophosphamide), and other medical issues... what do you think are the chances of me getting pregnant and successfully carrying full term? Is there a chance of passing all my medical problems onto the fetus? My GYN does not recommend pregnancy for me. She said it would be too high risk. My husband is also afraid of complications from a pregnancy hurting me more. I am curious to know what your thoughts are on this. I want to make sure I'm making the right decision with the full hysterectomy.
Thank you for your time.
AnswerHello,
There are several issues to consider:
1. Your age. Your natural chances of pregnancy is only about 0.5% per month of trying naturally. With IVF it would be 25% per attempt, so IVF would be your best option. The alternative for a higher chance of pregnancy would be donor eggs and IVF. There are some benefit to that which I'll cover below.
2. It is unknown for sure if your ovaries are still functioning and viable due to the chemotherapy. This certainly could have had an effect on your eggs, and most likely would lead to damage. In that case, your ovaries would stimulate but you would not produce viable embryos. The age factor will influence this as well and so your overall chances, with your own eggs would decrease. The alternative would then be donor eggs. In that case, none of your past history would be significant in terms of the fetus. There would be no risk of transmission of any abnormalities that you may have genetically. From all the different problems that you have, there is probably some sort of genetic predisposition that you are carrying and could potentially transfer. Donor egg IVF would given you a 50-60% chance of pregnancy per attempt.
3. In terms of pregnancy, you would definitely be a high risk pregnancy with all the autoimmune abnormalities going on. Your risks of miscarriage, even with donor eggs, would be increased. You are at risk of complications during pregnancy. It would be best for your to have a preconceptual consultation with a Perinatologist, and obstetrical subspecialist, who specializes in high risk pregnancies. They could give you a better idea of your risks.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
