Fertility and Metastatic Breast Cancer
If you are young and premenopausal, or still having menstrual periods, breast cancer treatments can affect your fertility and make it harder for you to become pregnant. Chemotherapy can damage your ovaries, and hormonal therapy such as tamoxifen may also cause your periods to become irregular or stop.
Most doctors advise women to avoid getting pregnant while undergoing breast cancer treatment and wait for a period of time after treatment ends before trying to get pregnant.
But what if you require long-term, ongoing treatment? Are there ways you can protect your fertility and become pregnant in the future?
As a young woman with metastatic breast cancer, you face a number of challenges that may affect your ability and plans to have children. This section is designed to help you navigate these issues so you can make informed decisions.
It’s important that you ask your doctor about fertility-saving options as soon as possible after your diagnosis; if you are already in treatment, talk with your doctors as soon as possible. Consult a fertility specialist, a doctor called a reproductive endocrinologist, who is experienced in treating women affected by breast cancer.
Chemotherapy that contains cyclophosphamide (Cytoxan) and high-dose treatment with other alkylating agents are more likely to cause infertility. If your doctors know you want to have children, they may be able to choose a treatment plan that does less harm to your fertility.
Assisted reproductive technology may help you become pregnant in the future. Harvesting and freezing eggs and embryos for future use is often coordinated with breast cancer treatment and performed before chemotherapy begins. Ovarian tissue freezing is also possible, but is considered very experimental.
You can also shut off your ovaries with medicine called gonadotropin releasing hormone agonist (GnRH agonists) or luteinizing hormone-releasing agonists (LHRH agonists). These medicines may stop the cancer from growing and protect your ovaries from the harsh effects of chemotherapy.
Women between the ages of 30 and 35 are more likely to ovulate and be fertile. However, because long-term, permanent treatment may take a higher toll on your fertility, you may have a higher likelihood of becoming infertile than a young woman with early-stage disease.
Even if you enter premature menopause, you can have frozen eggs or embryos implanted and carry a pregnancy. If you did not freeze eggs or embryos, you may be able to have a baby using donor eggs. If you are not able carry a pregnancy because of ongoing treatment or other issues, a gestational carrier, also called a surrogate, can carry the pregnancy for you. Adoption offers another route to parenthood, whether you are single or partnered.
For safety reasons, your doctor may advise you not to become pregnant while undergoing certain treatments.
Some situations prevent treatment breaks, such as fast-growing disease or cancer that causes pain or physical symptoms. But if the cancer has been stable for a time, your doctor may be open to interrupting treatment or, in some cases, delaying the start of treatment so that you can get pregnant and have children.
You may also be able to get pregnant and have children while continuing with certain treatments. Some studies suggest that women who receive chemotherapy at appropriate times during pregnancy, with precautions to protect the fetus, give birth to babies who show no long-term effects from treatment. Changes may include using older medicines, where we have much more information about their impact during pregnancy. Studies have also shown that infants exposed to chemotherapy during pregnancy show normal development after birth.
Talk with your healthcare team about your options.
Consider asking these questions, along with others that may be important to you:
- What is my prognosis (outlook for future impact of breast cancer) and any ongoing treatment I might need?
- How will the recommended breast cancer treatment affect my fertility?
- Can I postpone treatment long enough (2 to 6 weeks) to have my eggs extracted for future use?
- Can this be done before the start of chemotherapy?
- What fertility preservation methods might help me?
- What are the chances at my age that I will be able to become pregnant?
- If I’ve already had some treatment, what can I do to help my fertility?
- Can I take a treatment break to get pregnant?
- What are my options if I go into permanent menopause?
- How much will assisted reproduction (fertility) procedures cost?