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Diagnosed with PCOS. Family history of breast cancer and ovarian cancer. Over weight. Tested for for BRCA1 gene mutations. Pregnancy?

Mar 2013
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Practicing since : 1998
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Dear Doctor,

I am a 30 year old married woman diagnosed with PCOS and have been living with it from past 17 odd years. I have a family history of breast cancer and ovarian cancer (through paternal and maternal aunts), though I have never got myself checked for BRCA1 gene mutations. Do I have an increased risk of cancer if I undergo ovulation induction to achieve pregnancy?? I am almost 30 kilos overweight with elevated levels of testosterone (1.13). Is it a better idea to loose weight and try to conceive or to go in for assisted reproduction techniques?? We have been trying from past 4 years so do not wish to loose out more time trying naturally either.
Posted Wed, 31 Jul 2013 in Menstruation and Miscarriage
Answered by Dr. Aarti Abraham 30 minutes later
Thanks for writing to us at Healthcare Magic.
There are no definitive studies which indicate that women who undergo ovulation induction have a higher risk of ovarian / breast or hormonal cancers.
Some ( very few ) studies do point to a very slightly increased risk, but these have been criticized and not widely accepted.
In short, there is no current evidence that ovulation induction increases the risk of cancers.
After 4 years of trying to conceive, you should definitely not wait anymore before seeking treatment.
Before proceeding for ovulation induction, do consider testing the patency of your fallopian tubes via a hystero - laparoscopy.
A semen analysis is a must.
A thorough PCOS workup is essential - a checklist would include AMH, Day 2 FSH and LH, serum prolactin, TSH, S. testosterone ( free ), S. DHEAS, S. fasting insulin, C peptide, oral glucose tolerance test, baseline transvaginal ultrasound .
A cycle of follicular monitoring would show you the possibility of response to stimulation.
Women with PCOS have good chances of responding to ART ( assisted reproduction techniques ).
You can go in for 3 - 4 trials of stimulation with clomiphene plus or minus injections followed by trials of IUI ( intra uterine insemination ) before going in for IVF ( in vitro fertilization ).
Weight loss is the keystone of therapy.
You should not WAIT per se for treatment anymore.
However, weight loss efforts and ART can go hand in hand.
Weight loss impacts the metabolic problems of PCOS very favourably.
Even a 5 % weight loss will help in achieving favourable results with regards to your testosterone levels, your period patterns and of course, in ovulation and conception.
You should seek the help of a Dietician, a fitness trainer and a renowned Infertility expert so that you can achieve desired weight loss as well as conception within the coming year.

Take care, and feel free to discuss the issue further.
All the best.
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