Full-term pregnancy in breast cancer survivor with fertility preservation: A case report and review of literature

Abstract

A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother. Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2], which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient's optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient (> 40-year-old); endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology (all resolved prior to the embryo transfer); and a low quantity of ovules (low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding.

Keywords: Breast cancer; Case report; Endometriosis; Fertility preservation; Gonadotoxicity; Hydrosalpinx; In vitro fertilization; Pregnancy.

Figure 1

Chronological axis of the patient’s medical history.

Figure 2

Mammary ultrasound image. Asterisk showing solid tumour, badly defined, irregular and blurry borders with light posterior shadow. Signs of malignancy on ultrasound.

Figure 3

Transvaginal gynecological ultrasound. Asterisk shows ovarian cystic tumour containing clear liquid, well-defined borders, and smooth internal walls, suggesting serous ovarian cyst.

Figure 4

Transvaginal gynecological ultrasound. Asterisks show complex paraovarian tumor, multilobed, containing liquid and semiliquid, well defined, and with internal walls, suggesting hydrosalpinx. Doppler map of low vascularization and Doppler fluxometry with normal resistances.

Figure 5

Type A embryo transferred to the patient.

Figure 6

Abdominal obstetric ultrasound. Dorso-posterior feed with first fetal position of a second trimester fetus.