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Living with Breast Cancer: Fertility and Pregnancy

If you are a woman diagnosed with breast cancer during your child-bearing years, you may have questions and concerns about how breast cancer treatment can affect your fertility and the ability to conceive. If you think you may wish to become pregnant after your breast cancer treatment ends, it’s important to discuss your fertility options with your oncologistOncologist:
A doctor or surgeon who specializes in treating cancer. A medical oncologist specializes in drug therapy (chemotherapy) for cancer. A radiation oncologist specializes in treating cancer with radiation.
and other members of your health care team as soon as possible before you start treatment.

Pregnancy and Breast Cancer

If you are diagnosed with breast cancer during your child-bearing years, it is important to know the following:

  • If you are pregnant at the time of your diagnosis, inform your health care team. Some treatments are not appropriate for pregnant women, as there may be risks to the fetus.

  • It is not recommended to become pregnant during breast cancer treatment because pregnancy may complicate your treatment, and some treatments may pose a risk to the fetus. Therefore, if there is a chance you could become pregnant you may need to discuss options for birth control during this time. Speak to your health care team for advice about appropriate methods of birth control while you are being treated for breast cancer.

  • Becoming pregnant after your breast cancer treatment is complete does not increase your risk of breast cancer recurrence.Recurrence:
    Cancer that returns after treatment.

  • If you are considering becoming pregnant after your breast cancer treatment is complete, have a conversation with your health care team about your plans. Generally it’s advised to wait at least 2 years after completing your breast cancer treatment before trying to get pregnant, however, your health care team may recommend a different time frame based on your individual case.

How Treatment Can Affect Fertility

Some of the treatments for breast cancer can affect your fertility and your ability to conceive. If becoming pregnant in the future may be important to you, there may be treatment options available that do not affect your fertility. It’s important to discuss your fertility with your health care team as soon as possible before you begin treatment.

Some chemotherapyChemotherapy:
A treatment method that uses medication to destroy cancer cells.
and hormone therapyHormone therapy:
A treatment method for breast cancer that uses medication to block the production of the hormone estrogen, or the way that it works in the body.
treatments can lead to infertilityInfertility:
The inability to produce a child. In women, this can mean an inability to conceive or carry a child to term. In men, this refers to the inability to impregnate a woman.
:

Some women’s breast cancer treatment includes ovarian suppression, which is treatment to stop hormoneHormone:
A natural substance released into the body by the endocrine glands, such as the thyroid, adrenal gland or ovaries.
production in the ovaries. Ovarian suppression through surgery or radiationRadiation therapy:
(Sometimes called radiotherapy) A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.
is permanent and results in infertility, while ovarian suppression using medication may be reversible.

Consider Fertility Options in Your Treatment Plan

There are women who go on to become pregnant after their breast cancer treatment is complete. Options that may be available to you include having fertilized or unfertilized eggs frozen.  These fertility preservation techniques cannot guarantee that you will become pregnant, but advancements in fertility treatments are improving success rates.

If chemotherapy is part of your treatment plan, these fertility preservation procedures will take place before you have chemotherapy. Fertility treatments can take several weeks, and your oncologist may advise against waiting to begin breast cancer treatment. Evidence shows that it can be safe to start chemotherapy up to 12 weeks after surgery. Discuss the timing of your chemotherapy treatments with your oncologist to understand the options available to you and their potential impact on treatment outcomes to help you make an informed decision that’s right for you.

Having eggs or embryosEmbryo:
A fertilized egg in the early stages of development.
frozen begins with taking fertility medications to stimulate your ovaries to develop multiple eggs, which are then removed from your body through the vagina. If you have a male partner, their sperm, or that of a sperm donor, can be used to fertilize your eggs to produce embryos. This is done outside of the body in a lab and this procedure is known as in-vitro fertilizationIn vitro fertilization (IVF):
A fertility procedure that involves removing eggs from a woman’s body, fertilizing them in a laboratory dish, and implanting one or more of resulting embryos in a woman’s uterus.
. Once the embryos have reached a certain size, they will be frozen.  If you wish to become pregnant in the future, one or more of the embryos would be transferred to your uterus. Not all embryos will implant into the uterus, and several attempts may be required.

Having unfertilized eggs frozen is another option.  If you wish to become pregnant in the future, your eggs could then be fertilized with your partner’s sperm or donor sperm. This process is the same as in-vitro fertilization.  Having embryos frozen tends to be slightly more successful at achieving pregnancy than freezing unfertilized eggs, which can be damaged by the cold temperatures. As fertility treatments become more advanced, success rates are likely to improve.

It is important to ask your health care provider about options to preserve your fertility as soon as possible after you are diagnosed, even before you see a medical oncologist. It not only gives you more time to make a decision, but has some medical advantages. It may avoid the need for treatment delay, and allow for extra cycles of ovary stimulation to obtain healthy eggs.

An important factor that may influence your decision to undergo fertility preservation is the cost associated with the procedure and storage of eggs and embryos. There are organizations, such as Fertile Future, which provide some financial support toward these procedures for individuals with cancer. You can also speak to your health care provider or a social worker who may be able to direct you to other resources available to you.

If you are a woman diagnosed with breast cancer during your child-bearing years, and wish to become pregnant in the future, speak with your health care team for advice.  As you weigh the benefits and risks of different treatment options, you may wish to include fertility concerns in your decision making process.


Sources:

Cancer Research UK. Women’s fertility and chemotherapy. Accessed January 15, 2014.

Infertility Awareness Association of Canada. Freezing and Fertility: What’s it all About? Accessed January 15, 2014.