Protecting your fertility during treatment

If you are premenopausalinfo-icon (still having menstrual periods), breast cancer treatments such as chemotherapy and hormonal therapy can affect your fertilityinfo-icon. This may make it harder to become pregnant after treatment ends.

If you have just been diagnosed, it is important to discuss your fertility concerns with your healthcare team before starting breast cancer treatment. Your doctor may refer you to a fertility specialistinfo-icon, a doctor called a reproductive endocrinologist, who can help you learn more about the possible impact of treatment and ways to preserve your fertility. You may also find the Society for Assisted Reproductive Technology helpful.

Here are some methods that can help you protect your fertility after breast cancer treatment. For more information, visit our oncofertility tool. 

Freezing Eggs and Embryos

The best time to take eggs from your ovaries for future use is before treatment begins. For this process, fertilityinfo-icon medicines are usually given for about 2 weeks to increase the number of eggs your body makes. Your doctor may give you tamoxifeninfo-icon, an aromatase inhibitorinfo-icon, or both during the egg-stimulating cycle, to lower possible exposure of your breasts to estrogeninfo-icon.

The eggs are removed during an outpatientinfo-icon surgeryinfo-icon procedure. They may be frozen without being fertilized, or fertilized in a lab with sperm from your partner or a sperm donor. Then they are grown to form embryos. The eggs and embryos are frozen for use after breast cancer treatment. It is possible to have pre-implantation genetic testinginfo-icon to screen the embryos for chromosomal abnormalities or specific cancer risk geneinfo-icon mutations, if you have a known breast cancer gene mutationinfo-icon in your family. Your fertility specialistinfo-icon will have more information on these tests.  

Egg or embryo freezing is the standard-of-care approach and most common method to preserve fertility. This process takes 2 to 6 weeks. Freezing your ovarianinfo-icon tissueinfo-icon or using medicines called GnRH agonists to suppress your ovaries are also possible, but both are considered experimentalinfo-icon.

Fertility procedures often are coordinated with breast cancer treatment, usually during the weeks between surgery and chemotherapyinfo-icon. It can be stressful to make decisions about fertility right after a breast cancer diagnosisinfo-icon. You may want to get started with treatment quickly, or your doctors might recommend neoadjuvant therapyinfo-icon. Or maybe you haven’t thought about having future children, and cancer is now forcing you to do so.

Talk with your oncologistinfo-icon about timing—there may be ways to make a schedule work for you. Your oncologist can also communicate with the reproductive endocrinologist. This helps all your providers understand the timing for these procedures.  

Ovarian Suppression: LHRH agonists

Some studies have shown that medicines called gonadotropin releasing hormoneinfo-icon agonists (GnRH agonists) or luteinizing hormone-releasing agonists (LHRH agonists) may protect the ovaries from the harsh effects of chemotherapyinfo-icon so they can recover more fully and quickly. These medicines shut down, or suppress, your ovaries. They cause menopausal symptoms for as long as you take them. Shutting down your ovaries reduces the amount of estrogeninfo-icon your body makes.

The LHRH agonists are:

  • goserelininfo-icon (Zoladex)
  • leuprolide (Lupron)
  • triptorelin (Trelstar)

Ask your doctors to be specific about what kind of ovarian suppressioninfo-icon they recommend. Some doctors use “ovarian suppression” or “ovarian ablationinfo-icon” to mean the same thing. Ovarian ablation can also mean surgeryinfo-icon to permanently remove your ovaries.

LHRH agonists are given as an injectioninfo-icon once a month, every 3 months, or as an implantinfo-icon that lasts 3 months.

Side effects may include

  • bone thinning
  • bone pain
  • fatigueinfo-icon
  • headache
  • hot flashes
  • insomniainfo-icon
  • joint and muscle aches
  • loss of sexual interest
  • mood changes
  • sweating
  • vaginal dryness
  • weight gain

LHRH agonists are still under study. Note that this approach does not take the place of standard methods of preserving your fertilityinfo-icon, such as freezing eggs and embryos. Not enough research has compared whether LHRH agonists during chemotherapy results in higher fertility after chemotherapy compared to placeboinfo-icon treatment. 

Less Toxic Chemotherapy Medicines

Some chemotherapyinfo-icon medicines may cause less damage to your reproductive organs, but be less effective at treating the cancer. Talk with your doctor about which chemotherapy treatments have a greater chance of protecting your fertilityinfo-icon

The video on this page was supported by the Grant or Cooperative Agreement Number 1 NU58DP006672, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

August 6, 2019
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