Breast Cancer & Fertility
Breast Cancer & Fertility
Breast Cancer is a disease that is occurring in younger women much more commonly than it used to be due to change in the natural history of the disease. As a result the management of cancer will have an impact on the fertility of the women and needs family planning.
How Breast Cancer and Its Treatments Affect Fertility
Chemotherapy can damage ovarian follicles, leading to reduced ovarian reserve or premature ovarian insufficiency (POI).
The risk of infertility depends on:
- Age: Older women have a higher risk due to a naturally lower ovarian reserve.
- Type of drugs: Alkylating agents (e.g., cyclophosphamide) are particularly damaging to the ovaries.
- Dosage and duration: Higher doses increase the risk.
- Treatments like tamoxifen or aromatase inhibitors are used for hormone receptor-positive breast cancer.
- They don't directly cause infertility but require 5–10 years of treatment, which may delay childbearing.
- Pregnancy is generally not advised during hormone therapy.
Radiation targeting areas near the ovaries can lead to ovarian damage, but this is rare for breast cancer.
Surgery itself doesn’t impact fertility but may affect lactation if breast tissue is removed.
Chemotherapy is received by most patients and if the lady is in child bearing age and desirous of retaining fertility, it is important to take effective steps before embarking on the treatment journey.
Fertility Preservation Options
1. Embryo Cryopreservation
Process : Fertility medications stimulate the ovaries to produce eggs, which are then retrieved, fertilized with sperm, and frozen as embryos.
Pros : High success rates for future pregnancies.
Considerations : Requires sperm from a partner or donor.
Pros : High success rates for future pregnancies.
Considerations : Requires sperm from a partner or donor.
3. Ovarian Tissue Cryopreservation
Process : A portion of ovarian tissue is surgically removed and frozen for reimplantation after cancer treatment.
Pros : Experimental but offers potential for restoring natural fertility and hormonal function.
Pros : Experimental but offers potential for restoring natural fertility and hormonal function.
2. Egg (Oocyte) Cryopreservation
Process : Similar to embryo freezing, but unfertilized eggs are frozen for future use.
Pros : Suitable for patients without a current partner or those who prefer not to use sperm at the time of preservation.
Pros : Suitable for patients without a current partner or those who prefer not to use sperm at the time of preservation.
4. Ovarian Suppression with GnRH Agonists
Process : Medications like leuprolide temporarily suppress ovarian function during chemotherapy.
Pros : May protect ovarian function and reduce the risk of POI.
Limitations : Less reliable than cryopreservation techniques.
Pros : May protect ovarian function and reduce the risk of POI.
Limitations : Less reliable than cryopreservation techniques.
Family-Building Options After Treatment
- Many women regain fertility after treatment, though this depends on age and ovarian reserve.
- Consultation with a fertility specialist is recommended to assess reproductive potential.
- Includes in vitro fertilization (IVF) with frozen eggs/embryos or donor eggs/embryos if ovarian function is compromised.
- An option for women unable to carry a pregnancy due to treatment or health concerns.
- A non-biological pathway for building a family.
Timing Pregnancy After Breast Cancer
- Hormone Receptor-Negative Breast Cancer: Patients can consider pregnancy after completing active treatment (usually 1–2 years post-treatment).
- Hormone Receptor-Positive Breast Cancer : o Pregnancy is often delayed until after completing hormone therapy (5–10 years).
Safety of Pregnancy After Breast Cancer
- Pregnancy does not increase the risk of breast cancer recurrence, even for hormone receptor-positive cancers.
- Close monitoring during pregnancy is essential to ensure maternal and fetal health.
Breastfeeding After Breast Cancer
Feasibility:
- Women with one intact breast can often breastfeed from that breast.
- Radiation or surgery can impair milk production in the treated breast.
Safety:
- Breastfeeding after breast cancer treatment is safe and doesn’t increase recurrence risk.