If you’ve been diagnosed with or treated for breast cancer, you might already be thinking about fertility preservation options or find yourself worrying whether you will still be able to conceive after you finish treatment. Studies suggest no known evidence of an increased risk of recurrence with pregnancy. However, there is still the possibility of a reduced chance of falling pregnant due to the effects of long-term treatment.
The choice to try for children will be personal to everyone, depending on your circumstances and diagnosis. Here are a few things to consider when making this decision:
- Your current age
- The stage and type of your cancer
- Your treatment regime and if you will be undergoing ongoing treatment
Deciding to have children after breast cancer may feel daunting and confusing. To help you better understand your options, this article will discuss the effects of breast cancer treatment on fertility and which options you may have for fertility preservation.
*As always, it is recommended that you speak with your medical professional to ensure you are making the best decision for yourself and your family.
How does treatment affect fertility?
When you are diagnosed with breast cancer, there will be treatment options to consider, some of which will put a temporary or permanent hold on your ability to conceive. For a premenopausal woman, undergoing chemotherapy will often mean that you will experience a temporary absence of your menstrual period–commonly referred to as chemotherapy-induced amenorrhea. [1]
In most cases, a regular period should return a few months to a year after treatment is finished. However, there are some instances where a young woman’s menstrual cycle may never return, leaving her in permanent menopause.
Below you will find the different types of treatment and each of their effect on fertility:
Chemotherapy
Not every woman will experience menopause while undergoing chemotherapy, but the dosage of the drugs and length of treatment will almost always damage the ovaries in some way. This can include:
- Partially damaging healthy eggs
- Affecting the overall function of the ovaries
- Reducing quality and number of eggs, making fertilisation difficult
It is important to note that even if your period returns to normal after chemotherapy, there is an increased risk that you will have early onset menopause, typically 5-10 years earlier than if you didn’t undergo treatment.
Oophorectomy
If a woman tests positive for the BRCA gene mutation [2], her treatment plan may include an Oophorectomy, which means her ovaries will be removed entirely to reduce further risk. Unfortunately, this surgery will leave the woman permanently unable to conceive, but this does not mean she cannot bear children. In this case, a woman could consider egg or embryo donations in the future and should still be able to carry her child full-term successfully.
Herceptin (Trastuzumab)
A woman with a HER2-positive breast cancer diagnosis will usually be placed on Herceptin. This targeted therapy encourages the body’s immune system to help fight off and destroy cancer cells and reduces the cancer cell’s ability to divide and grow [3]. There are no known long-term effects of this drug on fertility. However, it is recommended to avoid falling pregnant while on this targeted treatment.
Tamoxifen
Some women may require ongoing treatment like hormonal therapy, which could increase the wait time of trying for a baby by a few extra years. Tamoxifen is used to treat hormone receptor-positive breast cancer. It is generally taken for 5-10 years to reduce the risk of recurrence [4] or to treat those with an increased risk of breast cancer due to gene mutation or family history. This drug is known to cause birth defects, so it should not be taken during pregnancy, but if a woman would like to start a family, there is an option to pause treatment.
When can I start trying for a family?
In many cases, pregnancy after breast cancer is safe for bub and mum, but medical teams suggest that you wait at least 2-3 years until the completion of all treatments before trying to conceive. In doing so, any damaged eggs will have time to move through the body [5], allowing yourself adequate time to heal and recover, making it the optimal environment for the baby to grow and thrive. Some specialists may also suggest waiting up to 5 years to ensure you are at less risk of recurrence.
Fertility Preservation Before Treatment
When you are first diagnosed with breast cancer, you may feel there is so much overwhelming information to remember. Though the priority will be on your treatment plan and survival, the future ability to bear children will also be a naturally occurring worry for many; this is perfectly normal, and you are not alone!
In many situations, you will have time to decide which fertility preservation option you’d like to use before starting treatment. However, some will take the ‘wait and see’ approach and start treatment immediately, taking the risk of permanent infertility or decreasing the chances of falling pregnant in the future. Below are some ways you can preserve your fertility before treatment:
IVF
In Vitro Fertilisation, IVF, is a laboratory procedure done before the start of treatment that involves removing the healthy eggs from a woman’s ovaries and fertilising them with sperm. Once this is done, the embryo can be frozen and stored until the woman is ready to start trying for children. IVF involves a five-step process [6]:
- Stimulation of ovaries through the use of hormones – this will be done throughout self-injections, allowing for an increased number of mature eggs to be collected at the end of the cycle. During this process, you will also have regular blood tests to measure hormone levels, helping determine the best time for collection.
- Egg collection – involves a minor surgical procedure usually done under sedation or general anesthesia.
- Insemination & fertilisation – here, the best quality eggs are selected. They are then combined with the sperm for fertilisation. In this step, the sperm is also tested for quality to ensure the best results.
- Embryo culture & freezing – the embryo will now develop in a dish for approx. 2-5 days in a special solution designed to help them grow. If the woman is immediately ready for pregnancy, this embryo can be placed straight into the uterus or womb. Otherwise, it can be frozen and stored for future use.
- Embryo transfer (post-treatment) – once the woman is ready, the frozen embryo will be thawed and transferred via a procedure similar to a Pap smear. Though most of the originally frozen embryos will survive the freezing process, there is a possibility that some may not. In this instance, the woman may be required to repeat Step 1 to stimulate additional egg production.
*If you choose to proceed with IVF, it may delay the start of your treatment by 2-3 weeks, so it is important to speak to your fertility specialist and doctor to help make the best decision for you.
Side Effects of IVF
There are still no known long-term effects on overall health from IVF, and studies show no increased risk of breast cancer recurrence.
Commonly reported side effects may include [7]:
- Soreness or bruising on the injection site
- Bloating
- Breast tenderness
- Hot flushes
- Fatigue
- Mood swings
- Allergic reactions – skin itching or redness at the injection site
- Pelvic inflammation
- Emotional stress
- Ectopic pregnancy
- Possibility of multiple births
Cost of IVF
IVF costs vary per clinic and available Medicare / Private Health Fund reimbursements. It’s best to contact your nearest clinic for accurate quotes and speak to your health care provider about your eligibility for rebates.
IVF Clinics in Australia
There are many incredible IVF centres across Australia that are led by fertility specialists, nurses, scientists, and counsellors, all providing excellent care, IVF education and resources. Below you will find a few of the top fertility clinics in the country:
Egg Freezing – Cryopreservation
The Cryopreservation process is similar to IVF, except it involves freezing unfertilised mature eggs. Doing this allows for fertilising the eggs later or using a donor if required.
Fertility Preservation During Treatment
For some women, their breast cancer diagnosis requires immediate chemotherapy, which doesn’t leave time to preserve fertility before starting treatment. Here is what most medical teams may offer you if you have already begun treatment:
Ovarian Suppression
This method of fertility preservation uses hormone therapy drugs to ‘shut down’ the ovaries temporarily during chemotherapy, protecting them while you are undergoing treatment. This is usually done through monthly injections for as long as treatment is effective.
Side Effects
Women may experience similar side effects as those going through menopause:
- Night sweats
- Irritability
- Mood swings
- Hot flushes
- Fatigue
- Nausea
- Decrease in libido
Questions To Ask Your Specialist
You may feel unsure and perhaps, unprepared about what to ask your Oncologist or Fertility Specialist regarding preservation after a breast cancer diagnosis. Here are our top five questions that may be helpful:
- Do I need to start treatment immediately, or can I go over my options for preservation?
- What is my best option for fertility preservation based on my diagnosis and treatment plan?
- How does my age affect my fertility?
- How successful are the different preservation methods?
- Will my treatment still be effective if I stop Tamoxifen temporarily to start a family?
Having children after breast cancer may come with a few additional challenges, but it is absolutely possible for many. Every woman is different in how they respond to treatment, their cancer diagnosis, and their entire journey's effect on their fertility. If you have any specific questions or concerns, please speak with your Oncologist, fertility specialists, and treatment team to ensure you are comfortable and empowered with all the information you need to make the best decision for yourself and your family.
This content is brought to you in partnership with MSD and developed independently by the team at Pink Hope in consultation with medical experts
