Managing Fertility and Pregnancy during and after Breast Cancer

18:03 1st October 2019 | Cancer

breast cancer Hormonal Therapy premenopausal Ovarian Shutdown Chemotherapy menopause Radiation Therapy Oocyte Preservation Egg freezing

When you're diagnosed with breast cancer, so many emotions arise and you have so many decisions to make. It can be overwhelming. And if you want to get pregnant and have children in the future, the medical decisions become even more complex.

Many women diagnosed with breast cancer have fertility concerns. But because each woman's situation is unique, it's not easy to study pregnancy in women with breast cancer or women who have been treated for breast cancer. It's difficult to find women with the same cancer status and fertility outcomes who can be compared in randomized clinical trials. The studies done so far have mostly looked at small groups of women. Still, there are some guidelines and research results that can help you and your doctor make decisions.

If having children is important to you, one of the most critical things you can do as you're planning your treatment is to talk to your doctor about your fertility options. Research shows that doctors often don't provide enough information about what can happen to fertility with different breast cancer treatments, and most doctors don't direct patients to fertility specialists for counselling before treatment begins. So if your doctor isn't starting the conversation, it's important to speak up about your concerns.

Some treatments for breast cancer can cause temporary infertility or make it harder for you to get pregnant after treatment ends. Other treatments cause permanent and irreversible menopause, which means you are permanently infertile.

It's likely that you'll receive more than one type of breast cancer treatment -- most people do. Use the links below to read more about how each treatment your doctor recommends can affect your fertility.

Fertility After Hormonal Therapy

There are three hormonal therapy medicines approved for treating premenopausal women:

• Tamoxifen

• Evista (chemical name: raloxifene)

• Fareston (chemical name: toremifene)

These hormonal therapy medicines can cause your periods to become irregular or stop and make your ovaries stop producing eggs. Many premenopausal women are still fertile and start their periods again after hormonal therapy treatment is done. But it's important to know that some women have problems getting pregnant after hormonal therapy.

Fertility After Ovarian Shutdown

• Ovarian shutdown (which can be done with medicine or surgery to remove the ovaries) is sometimes used to treat hormone-receptor-positive breast cancer or to reduce the risk for women at very high risk of breast cancer.

• Medicines such as Zoladex (chemical name: goserelin) or Lupron (chemical name: leuprolide) are used to temporarily stop the ovaries from making estrogen. These medicines cause temporary infertility. Fertility returns after you stop taking the medicine.

• If the ovaries are removed with surgery, infertility is permanent.

Fertility After Chemotherapy

Many women want to know if they'll be fertile after chemotherapy. Fertility after chemotherapy depends on two things: your age and the types and doses of chemotherapy medicines you get.

Your age: As every woman ages, her ovaries produce fewer fertile eggs. When you go into menopause, your ovaries stop making fertile eggs.

• Women who are treated for cancer younger than age 30 have the best chance of becoming pregnant after chemotherapy. Overall, the younger you are, the more likely it is your ovaries will recover after chemotherapy.

• The closer you are to menopause (the average age is 51), the more likely it is that you'll be in menopause after chemotherapy and won't be able to become pregnant.

• Women who are 40 or older when they get chemotherapy are more likely to be in menopause after chemotherapy.

Facts about the Effects of Chemotherapy on Fertility

• Early menopause brought on by chemotherapy may be temporary. In other words, your menstrual periods may stop and then start again after chemotherapy is over. It can take a few months or as long as a year or more for your periods to return.

• Periods don't always mean fertility. Even if your periods start after treatment, your fertility may be uncertain. You may need to see a fertility expert to help you find out if you're actually fertile.

• Women who get relatively high overall doses of chemotherapy may be more likely to be infertile after treatment than women on lower-dose regimens.

• Chemotherapy medicines are usually given in combination, not each one by itself. When used in combination, the medicines' effect on fertility may be different. It's also important to know that the same medicine may be given in different doses and in different combinations.

• Some women who have normal periods after chemotherapy may be able to get pregnant with no difficulty while others may have trouble getting pregnant. This is because chemotherapy can damage the immature eggs in the ovaries.

• When your periods return after chemotherapy, it means that some eggs are maturing. But the number of eggs available may be smaller than it was before chemotherapy.

• Because chemotherapy may cause birth defects, doctors advise using birth control -- but not birth control pills -- throughout chemotherapy so you don't become pregnant during treatment.

• It's important to wait at least 6 months (or longer) before getting pregnant after chemotherapy ends. You don't want to get pregnant with an egg that was damaged by chemotherapy.

• After chemotherapy, fertility may be short-lived. This means that even women whose periods start again after chemotherapy are at some risk of early menopause.

Fertility After Radiation Therapy

Radiation treatment for breast cancer has no effect on fertility.

But if you're also having chemotherapy and definitely want to get pregnant in the future, you may want to start fertility treatment BEFORE you start radiation. Fertility treatment may involve collecting eggs, fertilizing them, and saving them until after your treatment is completed.

The eggs for fertility treatment should be collected before radiation treatment starts. This is because the eggs that are beginning to mature for ovulation may be affected by tiny amounts of radiation that may scatter from the breast (the main treatment area).

Waiting until after your eggs are collected is unlikely to make radiation therapy any less effective.

It's also unlikely that the tiny amount of radiation that may scatter from the breast will affect the immature eggs in your ovaries.

Oocyte Preservation as your safety net

For some women, it is a necessity to freeze their gametes.

Egg freezing, also known as mature oocyte cryopreservation, is a method used to save women's ability to get pregnant in the future.

Eggs harvested from your ovaries are frozen unfertilized and stored for later use. A frozen egg can be thawed, combined with sperm in a lab and implanted in your uterus (in vitro fertilization).

There is usually a need to take this decision because of some indications, for instance, chemo/radiotherapy treatment (for cancer patients) which can impair one’s ability to conceive after recuperating.

Your doctor can help you understand how egg freezing works, the potential risks and whether this method of fertility preservation is right for you based on your needs and reproductive history. You can also learn more about the benefits and method of this procedure here.

Source: https://www.breastcancer.org/tips/fert_preg_adopt

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