Could a woman freeze eggs before Hodgkin treatment at 28?

Question

Hello doctor,

My 28-year-old daughter was diagnosed with Hodgkin lymphoma during her first pregnancy, and it has been a nightmare trying to figure out safe treatment options. She noticed swollen lymph nodes in her neck around 20 weeks of pregnancy, but doctors said it was due to regular pregnancy changes. By 32 weeks, the nodes had become very large, and a biopsy showed classical Hodgkin lymphoma stage 2A.

Her oncologist wanted to start ABVD (Adriamycin (Doxorubicin), Bleomycin, Vinblastine, and Dacarbazine) chemotherapy immediately, but we were terrified about the effects on the baby. She delivered a healthy baby girl at 36 weeks, but now needs to start treatment and cannot breastfeed. Her latest PET (positron emission tomography) scan shows that the disease has spread to the mediastinal nodes and spleen.

The Hodgkin lymphoma specialist says her age and pregnancy might have made it more aggressive. Her white blood cell count is 12,000, and LDH (lactate dehydrogenase) is elevated at 890, which indicates active disease. She had to stop working as a nurse because of the infection risk, and we are struggling financially. The fertility doctor said chemotherapy might affect her ability to have more children, which is devastating since she always wanted a big family.

Can egg freezing be done before starting treatment?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

That is really tough to go through, especially so soon after pregnancy. Hodgkin lymphoma diagnosed in pregnancy is rare, but it does happen, and sometimes the delay in diagnosis means the disease progresses by the time it is picked up.

The standard chemotherapy ABVD (Adriamycin (Doxorubicin), Bleomycin, Vinblastine, and Dacarbazine) is actually one of the safer regimens, even in late pregnancy. Still, since she has already delivered, she definitely needs to begin without delay. Breastfeeding, unfortunately, cannot be continued during chemotherapy. Fertility is a genuine concern; ABVD is less damaging than some regimens, but it can still reduce ovarian reserve.

The underlying Hodgkin lymphoma was diagnosed late in pregnancy and has now progressed to the mediastinum and spleen. A fertility workup may be considered, including AMH (anti-mullerian hormone) and antral follicle count. Detailed oncology staging with PET and laboratory tests is already being done, and infectious screening before chemotherapy, such as for HIV (human immunodeficiency virus), Hepatitis B, and Hepatitis C, is required.

She needs to start ABVD chemotherapy as soon as possible. Egg or embryo freezing can be considered, but practically, delaying chemotherapy for weeks is not advised when the disease is already active. Sometimes oncologists allow one quick cycle of ovarian stimulation and egg retrieval if the disease is stable. Still, in her case, with high LDH (lactate dehydrogenase) and spread, they usually recommend not to delay.

Ovarian suppression with GnRH (gonadotropin-releasing hormone) analog injections during chemotherapy should be discussed, as this can help preserve ovarian function to some extent. In the long term, options like egg donation, surrogacy, or adoption remain, but right now the priority is curing her lymphoma.

Good infection precautions at home are essential since immunity will drop with chemotherapy. Vaccinations may be reviewed after treatment. Emotional and financial counseling support should also be considered.

Please share her oncologist's treatment timeline and whether a fertility consultation has been coordinated. Ask specifically about ovarian suppression with GnRH during ABVD, as this can be started right away. Genetic counseling may not be needed here, as Hodgkin lymphoma is not linked to inherited cancer genes like BRCA. Close follow-up with oncology and fertility specialists together is essential.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.