Fertility After Breast Cancer

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Happy October, SD Mamas!

As most of you already know, October is Breast Cancer Awareness Month. While most of the posts you’ll see this month will be focused on early detection & prevention, I wanted to talk about an aspect of life after breast cancer. Did you know that less than 5 percent of women diagnosed with breast cancer in the United States are younger than 40 (1)? While that percentage is small, breast cancer is the leading cause of death from any type of cancer in women ages 20-39 (2).

That being said, there are thousands of young women who survive breast cancer and are left wondering if they can begin to have a family of their own. If you, or a close friend/family member, are a breast cancer survivor and are hoping to start a family post-treatment, here are a few pieces of information that will help you along your fertility journey.

How does chemotherapy affect fertility?

Chemotherapy drugs are designed to target cancer cells, but they also can affect healthy cells too (hence the hair loss, vomiting, fatigue, etc. during treatment).  Cancer researchers have determined that a woman’s fertility may return after chemotherapy but it may not last as long as it would in an otherwise healthy woman. Young women whose periods return after chemo are at risk for premature ovarian failure aka primary ovarian insufficiency. This means that her ovaries have stopped making estrogen and progesterone and thus she’s unable to get pregnant and sustain a pregnancy. 

Which drugs are most likely to cause egg damage & infertility?

According to the American Cancer Society he following chemo drugs are most likely to lead to egg damage and subsequent infertility:

  • Busulfan
  • Carboplatin
  • Carmustine (BCNU)
  • Chlorambucil
  • Cisplatin
  • Cyclophosphamide (Cytoxan ®)
  • Dacarbazine
  • Doxorubicin (Adriamycin®)
  • Ifosfamide
  • Lomustine (CCNU)
  • Mechlorethamine
  • Melphalan
  • Procarbazine
  • Temozolomide

The following drugs are less likely to lead to egg damage and subsequent infertility:

  • 5-fluorouracil (5-FU)
  • Bleomycin
  • Cytarabine
  • Dactinomycin
  • Daunorubicin
  • Fludarabine
  • Gemcitabine
  • Idarubicin
  • Methotrexate
  • Vinblastine
  • Vincristine

How long should I wait after treatment before TTC (trying to conceive)?

Most oncologists advise women not to get pregnant within the first 6 months after chemotherapy. Waiting at least 6 months gives your body time to allow undamaged eggs to mature. If a damaged egg is fertilized it could lead to a miscarriage or the development of a genetic defect in the fetus. This is definitely a topic you should bring up with your doctor before actively trying to conceive.

How can I preserve my fertility before treatment?

There are a number of factors that must be considered before attempting to preserve fertility in women with cancer:

  • Has the cancer metastasized or spread?
  • Do you have a high risk of getting cancer in your reproductive organs in the future?
  • Would it be too risky to delay starting cancer treatment to preserve your fertility? (some options to preserve fertility might take too long if the cancer is fast-growing)

Unfortunately, research studies have shown that women with cancer are less likely to be given information about preserving their fertility than men *insert eye roll*. Women who already have at least one child or those who are not married also are less likely to receive information *insert an even bigger eye roll*. 

It is important to remember that you can still choose to become a mom after surviving breast cancer. However, it might not happen the way you planned before you were diagnosed with cancer, but, you’ll find that you have a number of options. 

  • Egg freezing (freezing your eggs before fertilization with sperm)
  • Embryo freezing (freezing fertilized embryos)
  • Fertility sparing surgery
  • Surrogacy
  • Adoption
  • Donor eggs
  • Donor embryos

Remember, you are a rockstar! You’ve fought cancer & kicked its butt. Now, it’s time for you to stay encouraged as you navigate your fertility journey as a cancer survivor. There are many options and endless hope for you, dear sister! 

This month we celebrate you, a survivor and a soon to be mama–however that happens for you :)!

References:

  1. American Cancer Society. Breast Cancer Facts and Figures 2017-2018. Atlanta, GA: American Cancer Society, 2017.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 69(1):7-34, 2019.
  3. American Cancer Society. Cancer Facts and Figures 2018. Atlanta, GA: American Cancer Society, 2018.
  4. https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/treatment_and_services/survivorship/fertility_after_cancer.html
  5. Hickey M, Peate M, Saunders CM, Friedlander M. Breast cancer in young women and its impact on reproductive function. Hum Reprod Update. 2009;15:323-339.
  6. Metzger ML, Meacham LR, Patterson B, et al. Female reproductive health after childhood, adolescent, and young adult cancers: Guidelines for the assessment and management of female reproductive complications. J Clin Oncol. 2013;31(9):1239-1247.
  7. Nieman CL, Kazer R, Brannigan RE, et al. Cancer Survivors and Infertility: A Review of a New Problem and Novel Answers. J Support Oncol. 2006;4:171-178.

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