Many women wish to have a child after finishing treatment for breast cancer. It is possible to become pregnant after breast cancer, and studies show that pregnancy does not increase your risk of breast cancer reoccurring. However, it important to consult your treatment team when you’re considering becoming pregnant because some breast cancer treatments may affect your fertility. Careful planning can help you maintain your fertility during and after treatment.
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Treatment and your Fertility
Every woman’s experience with breast cancer is unique, which makes it difficult to generalize about how breast cancer treatment will affect your fertility. But there are still study results and guidelines that can help you and your doctor make decisions about pregnancy.
Some types of breast cancer treatment can cause temporary infertility, and some can make it harder to conceive when treatment is over. Other types of treatment can result in irreversible menopause, which means you will no be able to get pregnant. It is most likely that you will have more than one type of breast cancer treatment. Here is a rundown on how each treatment can affect your fertility.
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Hormone Therapy
There are currently three forms of hormone therapy for breast cancer. These are Tamoxifen, Fareston (toremifene), and Evista (raloxifene). These medications can cause your menstrual cycle to become irregular and prevent your ovaries from producing eggs. Many premenopausal women do start their periods again after hormone therapy, although a small number of women continue to have problems getting pregnant.
Chemotherapy
Whether you will be able to conceive after receiving chemotherapy will depend on two factors: your age and the types and doses of the medication you receive. As you age, your ovaries will produce fewer fertile eggs and will eventually stop producing them when you go into menopause. Generally, the younger you are when you have chemotherapy, the more likely it is that your ovaries continue to produce eggs after treatment.
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Some breast cancer chemotherapy medications are more likely than others to result in infertility. These include Cytoxan (cyclophosphamide), Adriamycin (doxorubicin), and Platinol (cisplatin). Chemotherapy drugs which are less likely to cause infertility include Methotrexate (rheumatrex, folex, mexate), Fluorouracil (adrucil), Vincristine (vincasar PES, vincrex, ncovin), Taxol (paclitaxel), Taxotere (docetaxel), and Abraxane (nab-paclitaxel, albumin-bound).
It’s hard to assess each individual woman’s chances of preserving her fertility because research into the effects of chemotherapy and fertility is surprisingly still limited. It is always a good idea to talk to your treatment team and a fertility expert about the potential risk of infertility – you want to be prepared and know this information before treatment begins.
Here are the known facts about chemotherapy and fertility:
- When chemotherapy causes early menopause, it may be temporary, and your periods may begin again when the treatment is over. It may take a few months for your regular menstrual cycle to return.
- Even if your periods do begin after chemotherapy, this does not necessarily mean you will be able to conceive. You may need to see an expert to assess your fertility.
- If you receive high doses of chemotherapy, this will increase your chance of being infertile after treatment.
- When used in combination, different chemotherapy medicine will affect fertility differently. Different amounts of the same medication will also have different effects on your fertility.
- Even if your periods begin again after chemotherapy, you are still at risk of early menopause.
- It is recommended that you wait at least six months to get pregnant after having chemotherapy. This is to ensure that you do not fertilize an egg which was damaged by the treatment.
Ovarian Shutdown
Ovarian shutdown is a procedure which is sometimes used to treat women with HRP (hormone-receptor-positive) breast cancer. It may also be used to treat women who are at a very high risk of breast cancer. It can be done with medications or surgery. Drugs such as Lupron (leuprolide) or Aoladex (goserelin) are used to prevent the production of estrogen in the ovaries. Fertility returns after you stop taking the medication. If your ovaries are surgically removed, infertility is permanent.
Radiation Therapy
Studies have confirmed radiation treatment for breast cancer does not have any effect on fertility. However, if you are having radiation therapy in combination with chemotherapy and you wish to become pregnant in the future, you may wish to begin fertility treatment before you begin radiation therapy.
Fertility treatment may involve harvesting your eggs, fertilizing them, and saving them until you have finished your treatment. Your eggs should be harvested before radiation treatment begins. This way, your eggs will not be affected by any amount of radiation which may scatter from the treatment area to other parts of your body.
Targeted Therapy
Medicine used for targeted therapy for breast cancer is relatively new. For this reason, not much research has been conducted on how these drugs may affect fertility. Because the drugs target specific characteristics of breast cancer cells, they are less likely than chemotherapy to affect healthy cells.
Planning a Pregnancy After Breast Cancer Treatment
If you are planning to get pregnant after treatment you should discuss this will your medical team as soon as possible. In order to see if your ovaries are working, your specialist will ask you some questions about your periods and whether you are experiencing menopause.
You will be given a series of blood tests to check your levels of follicle stimulating hormone (FSH). These tests will show whether or not you have gone through menopause. It may take up to six months after chemotherapy before your FSH level can be tested. Even though your periods have returned after treatment, you may still experience early menopause.
Many fertility specialists advise women to wait at least two years after breast cancer treatment before becoming pregnant. The reason for this is that over time, your risk of cancer coming back decreases. Your risk of recurrence is highest during the first two years after your diagnosis. However, waiting that long may not be appropriate for you. If you are considering becoming pregnant before the two-year period has passed, you should talk to a specialist who can discuss your options.
Considering Egg Donation
If your ovaries were damaged by your treatment, you may be able to get pregnant using eggs donated by fertile women. Donated eggs can be fertilized using sperm from your partner and then transferred to your womb. If you choose this procedure, you will need to take hormone medication for two weeks prior to the implantation, to prepare your womb for the embryo. If a pregnancy occurs, you will continue to take the drugs for up to 12 weeks.
If you have been diagnosed with breast cancer and you want to have children, it’s important to discuss your options with your doctor before treatment begins. You should also discuss how treatment could affect your fertility and what hormone medication may mean about the risk of your cancer returning. In most cases, this type of counseling can help you assess your options and make informed choices about your upcoming treatment as well as planning a pregnancy.
