Breast cancer and fertility
by Mindy Preston
Breast cancer affects one in eight women in developed countries, but diagnosis and treatment for breast cancer continues to improve. This has increased survival and quality of life following breast cancer. In the U.S. alone, around 3 million women are breast cancer survivors. Now more breast cancer survivors find themselves concerned with new issues. For younger women diagnosed with breast cancer, one issue is fertility. Each year there are 11,000 women under the age of 40 diagnosed with breast cancer in the U.S. Young breast cancer patients who have not started, or want to continue to have children, may have problems getting pregnant after chemotherapy treatment.
Chemotherapy has many side effects. One side effect is that it can kill the eggs in a woman’s ovaries. This can cause a woman’s ovaries to stop working for a while, or even completely stop working, which leads to premature menopause. Other types of breast cancer treatments can also reduce a woman’s chance to become pregnant again. One such treatment is with a hormone called tamoxifen. In addition, some younger women are encouraged to consider taking their ovaries out to decrease their risk for ovarian cancer. This would be the case for women who have a family history of breast and ovarian cancer. These two cancers are often seen together in some types of inherited cancer. (For more information about genetic risk for breast cancer, you can make an appointment to talk with a genetic counselor by calling VCU Massey Cancer Center at (804) 828-5116.)
Women who are interested in having children after their breast cancer diagnosis and treatments have a number of options. The most common method is in vitro fertilization. In IVF, eggs are collected from the woman and combined with sperm from her partner to create an embryo. These embryos can be frozen and used later to help the couple get pregnant after chemotherapy treatment. Another option is to have just the eggs frozen without the sperm. This method has a much lower pregnancy success rate than IVF. Both of these methods are expensive and often are not covered by insurance in Virginia.
Another technique allows ovarian tissue to be removed and frozen for later use. This tissue can be put back into the woman’s body after chemotherapy treatment has been completed. Very few babies have been born using this therapy. There is also research to see if ovarian tissue can be developed outside the body to make eggs that can be used in IVF. No babies have been born yet with this method. It may be many years before it ever works in women.
Other options use a hormone to stop women’s cycles before chemotherapy. This reduces the number of growing follicles that happen during chemotherapy. Oral contraceptive pills also work in the same way. These methods help with bleeding problems during therapy and also may protect more of the eggs in the ovary from damage from the chemotherapy. Adoption and using egg donors are alternatives for breast cancer patients to have more children if none of the previous options are available to them.
It is challenging to predict the ability to get pregnant following chemotherapy for breast cancer patients. There are tests that can be performed after chemotherapy that can provide information about how much damage occurred to the ovaries from the cancer treatment. Every woman is different based on her type of cancer, her age and what types of treatment she received. The potential risks and benefits of treatments should ideally be discussed with a specialist who knows about cancer treatments and also understands infertility diagnosis and treatments.
Patients or their providers can call (804) 327-8820 to make an appointment with a board-certified fertility specialist to answer questions and discuss what options are available to them.
About the author
Mindy Preston is a genetic counseling student in training at VCU Massey Cancer Center’s Familial Cancer Clinic.
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