Breast Cancer, Fertility and Pregnancy

Breast cancer could be a cause of fertility issues and women diagnosed with breast cancer have fertility concerns. While concerns are indeed valid, each woman’s situation is different and unique. There are guidelines and treatments available to help women who have battled breast cancer to achieve successful pregnancies.

Even though surgeries do not impact future fertility, chemotherapy does affect fertility to a significant extent and can bring forward the age of menopause. Studies have shown that even women who resume their periods following completion of chemotherapy may be less fertile.

The impact of chemotherapy on fertility is dependent on the age of the patient – specifically at which age they receive it and the drugs used. Needless to say, the impact on fertility is dependent on the types of drugs used and some chemo drugs are more adverse than others. We recommend that women with breast cancer, who may plan to have a baby in the future should be referred to a fertility specialist at the earliest for advice and management. Hormone therapy per se does not affect fertility but the duration of treatment of a few years when pregnancy is contraindicated could compromise fertility. There are treatment options such as GnRH (hormone) injections which can be used while the patients receive chemotherapy to minimise the damage on the ovary.

There are some other options available for fertility preservation that one could take before undergoing breast cancer treatment. While none of these options are perfect, they can indeed be good fall-back options and help in pregnancies in future, these options are:

1. Embryo Cryopreservation: For those who are married or with a partner, embryo cryopreservation is the best treatment choice. This involves going through the IVF (In Vitro Fertilisation) process, forming embryos and freezing them for future use. This achieves a pregnancy rate of around 50% per transfer of two to three embryos on average. However, it requires time for a woman to undergo ovarian stimulation but this could easily be scheduled after surgery while recovering from the surgery prior to starting chemotherapy. This option uses ‘anti-estrogens’  with the ovarian stimulation protocol to reduce the potential risk of elevated estradiol levels seen with IVF treatment.
2. Oocyte (egg) cryopreservation: This can be offered to young women who may not have a partner yet and may not be planning babies immediately. Though the chances of success when the frozen eggs are thawed to make embryos are less compared to embryo cryopreservation.
3. Ovarian tissue freezing: This method is still undergoing research and while very few pregnancies have been reported worldwide using this technique.

Many studies evaluating the safety of pregnancy after breast cancer have shown reassuring results showing that women who become pregnant are no more likely to suffer from a recurrence. So, when after the breast cancer treatment can one go forward with a pregnancy? It is ideal to wait at least two to three years to get through the early risk of recurrence and to complete endocrine therapy.

Getting diagnosed with breast cancer can be overwhelming and fertility issues are not always addressed adequately. The hope that fertility preservation offers can also serve as a strong impetus for a lady to deal with the diagnosis and treatment better.

Refer to a fertility specialist early for assistance in implementing fertility preservation procedures. Find out more about the procedure and clinics and choose carefully. Ask your specialists questions about the procedure your body will respond to.

We hope this information is helpful. For a more detailed discussion, book an appointment