Kutluk Oktay

Kutluk Oktay, MD, FACOG, is Associate Professor of Obstetrics and Gynecology at Weill Medical College of Cornell University and Associate Attending Physician in Obstetrics and Gynecology at Presbyterian New York Hospital. Following his graduation from Hacettepe University School of Medicine in Istanbul, Turkey, Dr. Oktay completed his subspecialty training in reproductive endocrinology and infertility at the University of Texas Health Science Center in San Antonio and at the University of Leeds in England. He is a diplomate of the Board of Obstetrics and Gynecology with a subspecialization in reproductive endocrinology and infertility.

Dr. Oktay's main expertise is on fertility preservation. He is one of the pioneers in ovarian cryopreservation and transplantation research, and was the first to perform an ovarian transplant procedure. Dr. Oktay has also developed special ovarian stimulation protocols for breast cancer patients to preserve fertility as well as treating infertility following cancer treatments. In addition, he is known for his contributions to basic research on ovarian follicle development. Among his many achievements, Dr. Oktay has published over 80 articles in peer-reviewed journals and text books, continues to lecture regularly in many international meetings, and has received numerous grant support. He has received many awards, including being recognized among the best doctors in New York by New York Magazine, and by Castle and Connolly as one of the top doctors in America on numerous occasions. He is also the President of the Fertility Preservation Special Interest Group at the American Society of Reproductive Medicine and holds a National Institutes of Health research grant to study the impact of cancer treatments on fertility.

Questions & Responses:

Question Ten:

What are the known risks of taking chemo or Herceptin during pregnancy- in general and after the first trimester?

How much damage can previous chemo regimens due to fertility, other than inducing menopause? What are the statistics of having permanent damage fertility-wise even if period returns?

Dr. Oktay:

There are no good statistics to show risk of infertility in women who retained periods after chemo. In one study that I performed, normally menstruating women who were in her mid thirties post chemo had less than 10% chance of having a baby with IVF. Herceptin and chemotherapy should not be used during the first trimester as they can interfere with fetal and placental development. Under special circumstances chemo can be administered after 20-24 wk of gestation with minimal risk

Question Nine:

What are your feelings about someone who is stage IV but NED and on maintenance treatment ( er/pr- ) attempting pregnancy? As adoption is not allowed for women in this situation, pregnancy is actually a more feasible option.

Dr. Oktay:

Depends on the other specifics. One can always consider using a surrogate. In general if the treatment has been successfully completed, there is no evidence that recurrence is increased after pregnancy in women with stage III or earlier stage

Question Eight:

I have just been told that I am looking at a metastatic breast cancer involvement in my lungs and my pelvic bone...I have just finished a 5 year tamoxifen cycle, and was hoping to start a family...what are the odds of that ever happening now, and what is the next step in getting the answers that I need to make a family happen? Is it possible to harvest eggs, if they are still viable, prior to treatment, even if the tumors or hormone positive?

Dr. Oktay:

This depends on your age, how much reserve of eggs are left after prior chemotherapy, and how much time you have before your next treatment. You must immediately seek expert help from a fertility preservation expert

Question Seven:

Assuming my ovaries and uterus remain intact and cancer free, will my body provide a healthy host for the fetus after chemo? Does chemo treatment make the womb environment unfavorable or unhealthy?

Dr. Oktay:

No, chemotherapy will not affect your uterus.

Question Six:

I am ER- / PR- and doing dense dose chemo (AC + T+ H). I want to know if these chemicals cause any damage to my eggs, or the DNA in my eggs. Let's say I do continue having my period and do not go into menopause, will my eggs still be healthy and good, i.e. equally as good, as they were prior to chemo? Will the egg/sperm fusion be affected? What about cell division and beyond?

Dr. Oktay:

Yes cyclophosphamide will cause damage to your eggs. There is no evidence that the surviving eggs will have residual DNA damage however your ability to conceive will be seriously compromised because of reduced egg count. Depending on your age you may experience immediate ovarian failure, if not menopause will occur earlier than usual. Also there is no evidence for alteration in egg/sperm fusion in surviving eggs.

Question Five:

I have been diagnosed with recurrent breast cancer and it is recommended I undergo 4 rounds of Taxotere / Cyclophosphamide. I had previously undergone 4 rounds of AC in 2005 and took Lupron to protect my ovaries during chemotherapy; my periods returned 3 months after finishing chemotherapy. I had banked embryos back in 2005, but my first frozen embryo transfer was unsuccessful. I am ER/PR & Her-2/neu Negative. Do you have any information on women becoming pregnant after undergoing chemotherapy twice? Is there any evidence that chemotherapy can affect your fertility in other ways other than the production of eggs i.e. I have frozen embryos but I am concerned that the long term effects of chemotherapy may affect my ability to sustain a pregnancy.

Dr. Oktay:

Chemotherapy does not affect your uterus and thus implantation should be normal. However since you received adriamycin you have a risk of developing cardiomyopathy during pregnancy. You should have a full cardiac evaluation before attempting.

Question Four:

I had stage one invasive ductal carcinoma May 2006 at the age of 31. I had a lumpectomy followed by 35 days of radiation which ended in August 2006. Although my oncologist suggested tamoxifen, I chose not to take it. Since January I tried to conceive, which I did in March, but I had a miscarriage in May. Is this common among young cancer survivors? Do young cancer survivors typically have fertility problems? Should I have waited longer before trying to conceive?

Dr. Oktay:

 If there was no chemotherapy, there is no evidence between breast cancer and infertility. One exception might be BRCA gene positive patients who may develop ovarian cancer which would interfere with fertility.

Question Three:

I am a YSC member and cancer free for almost three years. I was diagnosed at 32 and have no children. When I was diagnosed I was beginning the process of in-vitro fertilization, but didn't begin hormone treatment at that time. I had stage 1 ER+, PR+, Her2-, with a small high grade poorly differentiated infiltrating duct cancer in the right breast and stage 0 DCIS in the left breast, no node involvement, 4 cycles of AC. I am BRCA 1 neg and BRCA 2 uncertain significance, and was on tamoxifen for two years (been off since Jan '07). My oncologist said it was a low risk for me to come off tamoxifen early. My fertility doctor is telling me that in-vitro is the next best option and will increase my chances of conceiving, my oncologist is aware and agrees. Of course I have many questions, but what are the risks, if any, and is it dangerous to put hormones in my body three years after cancer? 

Dr. Oktay:

Compared to the estrogen exposure you will have during pregnancy, the exposure from fertility drugs is small. Nevertheless ovarian stimulation can be performed with letrozole to minimize increase in estrogen.

Question Two:

How accurately can hormone levels like FSH, Estradiol and LH be evaluated for fertility status post cancer treatment while one is on tamoxifen?

Dr. Oktay:

Tamoxifen can alter those levels in either direction to either falsely assure normalcy or erroneously indicate altered ovarian function. Levels should be assessed after discontinuing tamoxifen for 2 cycles.

Question One:

How long after stopping tamoxifen is it safe to try for a baby? I have been on tamoxifen since 10/06 and got the okay to try for children in July from my oncologist. I am 25, and took Zoladex from 1-07 to 4-07 but stopped due to side effects. My oncologist says give it about two months off the tamoxifen before trying. Any suggestions? Also, how long does it take after stopping Zoladex for your period to return and return to normal? Thanks for all you do for all of us.

Dr. Oktay:

Correct, 2 months should be sufficient. Return of periods may vary, depending on the dose. Usually you should get your period within three months after the scheduled date of skipped injection.