For many women, part of the worry and fear that come with a breast cancer diagnosis is related to concerns for the future. This is particularly true for those who are anxious to start their family or want to expand it. If you find yourself in this group, you are not alone. One recent survey published in the Journal of Clinical Oncology found that of 757 young breast cancer patients, 57% had concerns about their fertility, and 29% reported that these concerns impacted their treatment.
Fortunately, numerous advances have been made in medicine geared toward fertility preservation for those undergoing cancer treatment. Read on to understand how cancer treatment can affect your fertility and why fertility preservation before you start breast cancer treatment may be the most beneficial move to help you achieve your family planning goals.
There are several commonly prescribed breast cancer treatment options. Some may result in temporary infertility (causing your menstrual cycle to become irregular or stopping completely for a period of time), while other treatment options can result in permanent infertility.
For example, some women of reproductive age with breast cancer may be treated with therapy, tamoxifen, raloxifene, or toremifene. During treatment, these medications can cause irregular periods, or periods may stop occurring altogether. Fertility often returns once the hormone treatment is complete, yet some women may still have difficulty conceiving naturally. Medications like tamoxifen are often prescribed for a few years, which can be associated with a decline in natural fertility.
Chemotherapy for breast cancer treatment can lead to more permanent fertility issues, as it can damage eggs which can lead to early menopause. This is a risk factor that increases with age. Women who are closer to 40 tend to have a higher incidence of permanent menopause after treatment, according to The North American Menopause Society.
In some cases, a woman who has finished breast cancer treatment may be able to get pregnant without having previously completed fertility preservation. However, according to the American Cancer Society, it’s essential to understand that many healthcare providers recommend waiting two years to try to conceive to make sure the breast cancer doesn’t return. If your breast cancer treatment includes hormone therapy, you may continue treatment for five to 10 years. In that time, natural fertility can decline, treatment options aside.
In general, hormonal treatments for breast cancer should not be used during pregnancy. Some healthcare providers may advise you to complete two years of hormone therapy, wait a few months before trying to conceive, and then commence hormone therapy after the baby is born. Yet this may not be feasible for all women going through hormone therapy. Before starting hormone therapy, you should speak to your healthcare team to understand if this is an option for you, how it would affect your pregnancy should it happen, and your cancer and overall health.
Fertility preservation can provide reassurance that you will be able to achieve your family planning goals. You ultimately may not need it, but having it can help minimize risk regarding your family planning.
There are several fertility preservation options before or during breast cancer treatment. The most important step, however, is to mention to your healthcare provider that preserving your fertility is something you care about. While many physicians will discuss fertility preservation from the start, some may not. To be safe, don’t assume your medical team will approach the subject first. Be proactive – talk to them about your future family-building goals and ask what your options are to achieve them.
Every cancer case is unique, but here are some common fertility preservation techniques done today:
Cryopreservation is one of the most utilized fertility preservation methods available. During this process, the ovaries are stimulated through hormonal injections to help the oocytes (eggs) develop and mature. Once the oocytes are ready, you will have an egg retrieval procedure where the eggs will be surgically removed. The eggs will then be frozen or combined with sperm to produce an embryo.
Oocyte cryopreservation is so widely used the American Society of Reproductive Medicine states it is no longer an experimental procedure. Once you’ve got the green light from your physician to try to conceive, if you completed oocyte cryopreservation, the oocytes can be thawed to create embryos. The embryo will then be transferred into your body or to a surrogate if you cannot carry the pregnancy yourself.
For some people, particularly young girls who have not completed puberty or those who do not have the time needed for ovarian stimulation, ovarian tissue cryopreservation is an option. This allows healthy ovarian tissue to be frozen without a need to allow the eggs to mature and to reduce the risk of damaging the ovaries during chemotherapy. For this process, a specialist will remove and freeze the egg-producing area of the ovaries. Once treatment is complete, the tissue can be returned to the body, or the eggs within the tissue can be allowed to mature in the laboratory.
GnRh agonists are medications that inhibit the release of the hormones from the brain (gonadotropin-releasing hormone and follicle-stimulating hormone) that help the eggs to develop and mature, which puts the ovaries in a quiet state. The treatment occurs while you go through chemotherapy and reduces the exposure of the eggs and the fluid sacs they grow in (follicles) from the chemotherapy.
People treated with these medications are more likely to resume regular menstrual cycles and conceive once their cancer treatment is complete. While it can be used as the only fertility preservation option, it is often used in conjunction with other treatments, such as egg freezing.
GnRH therapy may not be an option for everyone, and although generally safe and well-tolerated, there may be associated side effects, specifically menopause-like symptoms or adverse health risks such as high blood pressure. If you are interested in this option, mention it to your healthcare team to see if it’s safe for you.
As you try to make sense of your breast cancer diagnosis, including what your life will look like during and after treatment, lean on this: Research presented at the San Antonio Breast Cancer Symposium states that while women treated for breast cancer have lower pregnancy rates compared to a woman who does not have breast cancer, a majority of breast cancer patients in remission who do conceive go on to have a healthy pregnancy and baby. Getting pregnant also does not impact your personal survival rate.
Take this knowledge and map out a game plan for your cancer treatment and life after. Speak to your healthcare team as early as possible about your plans for wanting to have a baby. Discuss which treatment options can help you achieve that and treat your cancer together. Write down a list of questions ahead of time, so you’re not relying on memory in this confusing and stressful time. Depending on the stage of your cancer and if it has spread, you may want to ask if you’re eligible for any clinical trials. If so, ask if that impacts your ability to preserve your fertility.
Your medical team is just one facet of your breast cancer journey. As you meet with your oncology team to grasp how often you’ll see them and the type of treatment you’ll need, make sure to assemble a strong family and friends support system. Breast cancer treatment can be tough, as can fertility preservation. You need people you can rely on to check in with you, set up meals, drive you to appointments, and offer emotional strength.
Next, make an appointment for a consultation with a fertility specialist at ORM Fertility. Speak with our team of providers about your breast cancer diagnosis. We can walk you through the fertility preservation options that will be the safest and most effective for you. We’ll work closely with your oncology team to ensure that the lines of communication are open regarding your treatment and when to begin fertility preservation, such as egg freezing.
We know that a cancer diagnosis can fast-track your fertility plans. At ORM Fertility, we’re here to help you expedite the fertility preservation process as much as possible. Our team will ensure you get an appointment quickly while providing you with the support and knowledge you need to make the best decision for your future fertility and family. Contact us today to schedule an appointment.