Fertility and Breast Cancer

One of the most common concerns of people diagnosed with cancer, particularly women, is how having cancer will affect their opportunities to have children later in life. Some cancer treatments, like surgery alone, pose a minimal risk to fertility. Other cancer treatments can have an impact on fertility. 

Fertility preservations options, treatment effects, and costs are the three biggest questions I continually get asked by my patients so I wanted to address them here. Please note that this is only general information that may or may not apply to your individual situation. Consult your treatment team and fertility specialist for information specific to your situation.

Fertility preservation options

Many patients choose fertility preservation as a precaution if their treatment team advises treatment can be delayed while fertility preservation takes place. For many women, this provides peace of mind, even if treatment is unlikely to affect fertility or if they’re not yet sure they will have children. 

Your treatment team can make referrals to fertility clinics if fertility preservation is something you are interested in. Fertility clinics also provide concessions to people with cancer and have worked extensively in fertility preservation for cancer patients, so know that you are in good hands.

The most common forms of fertility preservation are the freezing of embryos or eggs to be used for a future pregnancy. While these terms are often used interchangeably, there are some important distinctions between the two procedures that I go through. Ovarian suppression is also another fertility preservation option. You should carefully consider these options in consultation with your treatment team and fertility specialist to ensure they will not impact on your treatment or health outcomes, but at the same time honour what’s important to you.  

Embryo freezing 

One of the most effective methods of fertility preservation is embryo freezing where hormone stimulation medications are used to stimulate the ovaries, and usually between 6-15 eggs are harvested. After the eggs are removed, they are then fertilized with sperm to form embryos that can be frozen. When a person is ready, embryos can be thawed and implanted.

Embryo freezing is a great choice if you already have a partner who you want to start a family with, but it can also be an option if you wish to use a sperm donor. 

Egg freezing

Egg freezing is like embryo freezing, except the eggs are not fertilised prior to freezing. When a person is ready, the eggs can be thawed, fertilized with sperm (either from a partner or donor) and implanted.

Ovarian suppression

Ovarian suppression treatment involves the ovaries being temporarily shut down to protect them from the potential harms of cancer treatment. While ovaries are inactive, they are less likely to be damaged by the effects of chemotherapy.

Drugs to bring on temporary menopause are given as an injection and although they are generally safe, use beyond 18 months has been associated with side effects such as weakened bones, so this option is not usually recommended for people who are expected to be having chemotherapy treatments for longer periods of time.

Breast cancer treatments and fertility

Breast cancer treatment is unique to each patient and can involve surgery, chemotherapy, radiation therapy, hormone treatment or a combination of these treatments. These treatments each have different impacts on fertility, ranging from low risk to higher potential impact on fertility. 

Surgery 

Surgery is the most common form of treatment for breast cancer, and on its own poses minimal risk to fertility. However, surgery is often used in combination with other treatments for breast cancer which can impact on fertility.

Chemotherapy

Aside from surgery, chemotherapy is the most common type of treatment for breast cancer. Chemo prevents cancer cells from growing larger and reproducing but also has the same effect on healthy cells, including reproductive cells. This means that eggs, and the hormones producing cells around the eggs can be affected by this treatment. 

There are several different factors that determine the extent of the damage on these cells, including the type of chemo drugs used in a regime, their dosage and combination of other medications, as well as age at the start of treatment. 

Chemotherapy can have an impact on fertility so if this is a concern for you, consult your treatment team to understand the extent to which chemo is likely to impact your fertility. 

Radiation Therapy 

Radiation therapy aims to kill cancer cells in a specific part of the body unlike chemotherapy which affects the whole body. Radiation also has the effect of killing rapidly dividing cells, which can include reproductive cells, but is usually contained to those in the targeted area. 

Therefore, radiation is only likely to impact fertility if required in the reproductive area of the body. 

Hormone Treatment 

Some medications used to treat women with breast cancer will cause ovarian suppression, meaning that ovaries are prevented from producing oestrogen. However, in most cases this is temporary, and fertility will usually go back to normal after a medication regime has finished.

Costs

Across Australia, the cost of fertility preservation varies but fertility clinics often provide concessions to people with cancer. Even still, it can be a costly process, including fees for fertility specialist consultations, medications, procedures and day surgeries, and egg and embryo storage. Be sure to discuss any financial concerns with your treatment team so that they can refer you to a clinic that they know to provide concessions to people with cancer.

The fertility preservation process can cause delays in receiving treatment for breast cancer and for this reason, it may not be advisable or even possible to pursue fertility preservation in some cases. Sometimes treatment is needed right away, but this does not always mean that without fertility preservation a person will become infertile. Speak with your treatment team about any feelings, thoughts or concerns you are having. They have your health and wellbeing at the heart of what they do and should work collaboratively with you to understand what’s important to you and how best they can support you.