Breast Cancer

Effects of Cancer Treatment on Fertility

If you want the option of having biological children in the future, it is important to understand that many cancer treatments can cause temporary or permanent infertility. Therefore, before beginning any type of treatment, it is essential to talk to your oncologist and a fertility preservation specialist. Options for preserving your fertility become much more limited after treatment starts.

Fertility Requirements

The endocrine glands and related organs (ovaries, thyroid and adrenal gland) release hormones that control fertility in women. When cancer or its treatments damage one of these glands or organs or alter the area of the brain that controls the endocrine system, fertility can be affected.

To become pregnant (without reproductive assistance) after cancer treatment, you must have at least one healthy ovary to produce the egg, a healthy fallopian tube for the egg to travel through, a healthy uterus for the baby to grow inside and certain levels of specific hormones. Your ability to have a menstrual period following treatment generally predicts whether you are still able to become pregnant, but not always.

In general, if a woman receives breast cancer treatment before she turns 30, she has a better chance of remaining fertile afterwards, although several other variables play a role.

Different combinations of cancer therapies may affect your menstrual cycle differently, stopping it only temporarily instead of permanently, for example. However, be aware that even if your period does resume, it likely won’t happen for several months. In some cases, menstruation stops and then starts again years later. It is also important to know that in some women, cancer treatment may lead to early menopause, when menstrual periods stop permanently.

The longer it takes for your regular cycles to resume, the less time you will have to become pregnant. In addition, some health care providers recommend waiting at least 6 months after completing chemotherapy before trying to become pregnant. Other doctors may recommend waiting 2 to 5 years after a breast cancer diagnosis.

Treatments and their Effects

The effect of cancer treatment on your fertility largely depends on the type of therapies you received. Other factors include your type of breast cancer, age, gender and your body’s response to treatment.

Several treatment options, including chemotherapy, radiation therapy, targeted therapy, hormone therapy and immunotherapy, have the potential to cause fertility-related side effects. Other treatment-related side effects not directly related to fertility, such as a weakened heart, may also affect your ability to maintain a pregnancy or to go through labor safely.

Fertility preservation options may be available, such as having your eggs harvested, frozen and stored before you begin treatment or taking medication to suppress your ovaries during treatment. A fertility preservation specialist can make recommendations. Remember to also contact your health insurance provider to find out if your plan covers these expenses.

For men diagnosed with breast cancer, the cancer itself, chemotherapy, radiation therapy and hormone therapy have the potential to cause infertility by damaging sperm quality, lowering sperm production, altering hormone levels or resulting in impotence. The most common option for preserving a man’s fertility prior to cancer treatment is called sperm-banking, or sperm cryopreservation (freezing and storage). For men who do not choose to bank sperm prior to treatment, doctors usually recommend waiting 2 to 5 years to try to have a child.

Talk to your doctor about fertility implications related to your specific cancer treatments.

Your Feelings About Parenthood

If your cancer treatment plan poses a risk to your fertility and your future plans included parenthood, consider how important it is to you (and your partner, if you are in a relationship) to have a biological child. Consider your feelings about adoption; the time required for fertility preservation weighed against your cancer prognosis; and whether it would be acceptable to you to use donor eggs or sperm, a surrogate, or other assisted reproductive technologies to have a child. Understanding your feelings about parenthood will help you determine which options may be worthwhile to pursue. Talk to your doctor and/or a fertility specialist about all of your options. It may also be helpful to talk with a counselor who has experience with these issues.

Questions to Ask your Doctor about Treatment-related Fertility Issues

  • Will the recommended cancer treatment(s) affect my fertility?
  • Are there side effects not directly related to fertility that might make it difficult to conceive, maintain a pregnancy or give birth?
  • Would postponing treatment long enough to stimulate egg production and harvest eggs for freezing endanger my health?
  • How long after completing treatment do you recommend I wait before trying to get pregnant?
  • Will my cancer treatment pose any potential risks to my future children?
  • Can you recommend a fertility preservation specialist who works with cancer patients?
  • What are my fertility preservation options and how many weeks or months will each one take?
  • What are the costs and other considerations associated with each option?
  • If I choose not to preserve my fertility, what are my parenthood options after completing treatment?
  • After treatment ends, how will I know whether I’m fertile?
  • Where can I find resources and support for coping with cancer-related fertility issues?

Table 1. Fertility Preservation and Parenthood Options

Before treatment
▪ Egg freezing (freezing unfertilized eggs)
▪ Embryo freezing (fertilizing your eggs with sperm in a lab through in vitro fertilization [IVF]
  and then freezing the created embryos)
▪ Ovarian tissue freezing (freezing tissues containing stem cells from part or all of one
  ovary; requires less wait time than other options)
▪ Ovarian transposition (having your ovaries surgically moved higher up into your abdomen
  and out of the radiation field to minimize exposure and damage)
▪ Radical trachelectomy (for cervical cancer patients, the cervix is removed and the uterus is
  preserved)
During treatment
▪ Ovarian shielding (placing external shields over the site of your ovaries during radiation
  therapy to minimize exposure and damage)
▪ Ovarian suppression (taking a medication that causes the ovaries to temporarily shut
  down during chemotherapy)
After treatment
▪ Donor eggs
▪ Donor embryos
▪ Surrogacy or gestational carrier (having another woman carry your baby): A surrogate
  gives her egg and is the genetic mother of the baby; a gestational carrier accepts an
  embryo (does not give her egg) and has no genetic relationship to the baby
▪ Adoption
▪ Natural conception
▪ Assisted reproductive technologies (different fertility treatments that your doctor can use to
  help you get pregnant)
▪ Freezing eggs/using frozen eggs
▪ Freezing embryos/using frozen embryos
▪ Freezing ovarian tissue/using frozen ovarian tissue

Additional Resources

 

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