May 2015 Ask the Expert: Preserving Your Fertility After a Breast Cancer Diagnosis

May 1, 2015

If you’re a young woman who has been diagnosed with breast cancer, you may be worried about how your treatment will affect fertilityinfo-icon, your ability to become pregnant. Having breast cancer does not necessarily mean that you can’t have children in the future. But if you want to expand your family, it’s important that you learn as much as you can as early as possible.

This May, Living Beyond Breast Cancer expert Elizabeth S. Ginsburg, MD, answered your questions about how breast cancer treatments can affect your ability to have children and what you can do to preserve your fertility.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerinfo-icon because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counselinginfo-icon or medical advice.

Question: I did not do any egg preservation before I started chemo. I was told there was very little chance of getting pregnant after chemo. I have to wait one year after treatment with Herceptin before trying, which puts me at age 39. I have two kids but always wanted more. Is it likely that my body will be strong enough to handle a pregnancy? I worry that carrying a baby may make my health even worse.

Dr. Ginsburg: We do not worry about weakening of the uterus at all from chemotherapyinfo-icon. The issue will be whether you still have periods and are ovulating (releasing eggs). If you are now, and are still ovulating when your oncologistinfo-icon says it’s safe for you to become pregnant, then it’s certainly possible.

We do sometimes freeze eggs after chemotherapy. The response of the ovaries to the medications we use is typically low in women in their late 30s, but a blood test called an anti-mullerian hormoneinfo-icon (AMH) test can be done to determine whether they are likely to respond well or not. You should wait to get the AMH checked until at least 4 months after chemo ends though.

Question: What can be done to find out about your fertility while you’re on hormone suppression therapy?

Dr. Ginsburg: A blood test for anti-mullerian hormoneinfo-icon (AMH) can give a sense for the size of the pool of eggs still in the ovaries. It will be a bit lower while you are on suppression, but it is still useful. A normal level is 1.0 or higher.

Question: What are the chances of being fertile after chemo, bilateral mastectomy with axillary lymph nodes removed and 33 radiation treatments? I’m now taking monthly Zoladex and daily Femara. I’m 34 now, and was diagnosed last year at age 33.

Dr. Ginsburg: Pretty good, due to your age. Studies often don’t include women as young as you; on average the age of women is higher, and in the studies that have been done, 40 to 57 percent of women get pregnant after chemo. The radiationinfo-icon, mastectomies and lymph nodeinfo-icon dissections are not a problem. Just like any woman, age is the best predictor of fertilityinfo-icon – the younger you are, the better the likelihood of pregnancy, because the quality of eggs goes down as women age. If your doctor wants you on suppression for 10 years it would be worth discussing if taking a few-weeks break to freeze eggs now (if you didn’t before chemo) is an option. Someone else could carry the pregnancy for you if your doctors do not recommend you become pregnant.

Question: I’m 33 years old. My menstrual cycle came back a few months after chemo. When trying to get pregnant via in-vitro fertilization, I would get close to ovulation and then my hormones would drop down and ovulation would not happen. Is there any chance this could change further out from treatment or is it the start of menopause?

Dr. Ginsburg: I suspect these are unrelated. There are medications that can be used to prevent the drop in estrogeninfo-icon prior to egg retrieval in IVF. A small drop in estrogen is not a huge problem however, and retrieval can still be done in many cases. A year out from chemo your ovaries will have recovered fully, and at that time they would respond to IVF medications best.

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