Young women facing breast cancer have some special challenges to consider when making treatment decisions. About one-fourth of all breast cancer patients are between 18 and 45 years old, still in their fertile years. These women may have been diagnosed before, during, or after a pregnancy. Women who have never conceived may also develop breast cancer, as many women delay pregnancy for various reasons. Fertility declines naturally as we age, and treatments such as chemotherapy and radiation can reduce fertility even further.
Know Your Infertility Risk Before Starting Treatment
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If you are fertile before treatment begins and want to preserve your options for having children, or understand how this will affect your fertility, then this section is important to you. Please don't blindly go into treatment without first asking how this will impact your future family plans. Many women are shocked when they finish treatment and find that their ability to conceive is gone. You do have choices about this issue, but you must inform your doctor and discuss ways to preserve your fertility, if you choose. Even one chemo treatment may drastically lower your chances of being fertile afterwards. Take action and educate yourself on this subject before beginning treatment. Be as comfortable with your decision as you can.
Main Factors That Increase Risk of Infertility
Many women have survived treatment and gone on to successfully bear and nurse their own children. So how can you know if you're at risk for infertility after treatment? The type of treatment you'll receive has a lot to do with this, but here are some other critical factors:- Your age at treatment (menopausal status)
- Type of drugs used
- Dosage
How Chemotherapy Affects Fertility
Chemotherapy treatment for breast cancer has many side effects, one of which is estrogen suppression. This can cause your ovaries to stop working temporarily or permanently (see below). You should use contraception during treatment, because there's no guarantee that you won't become pregnant during treatment, and if you do, the drugs may hurt your baby. Fertility may return several months after treatment as your hormone levels rebound.Chemotherapy and Medical Menopause
If you are fertile before starting treatment, be aware that specific chemotherapy drugs can put you into temporary or permanent menopause. Your periods may stop, and you could experience temporary medical menopause. If you are close to the end of your fertile years, chemo may push you into early menopause. However, if you have several years of fertility left, and do not require the removal of your ovaries to prevent recurrence, you may be able to recover your fertility and try to become pregnant after completing all treatments.Radiation and Your Future Fertility
If you have radiation treatments to your breast, you are not likely to develop infertility, since the energy will not be directed at your reproductive organs. But if you need to have radiation in your pelvic area, that can affect your ovaries, eggs, and uterus. Since women have a lifetime-limited number of eggs, the quality of which declines over time, you may want to have your eggs removed and preserved.Hormone Therapy and Fertility
As part of your breast cancer treatment, you may need to take medications to lower your hormone levels after primary treatment is completed. Selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) are used to help prevent recurrence. These are taken for five years after your main treatments. It is not safe to become pregnant while taking these medications, because they can harm your baby.Taking Action Before Treatment Begins
Talk with your oncologist before starting treatment. Ask if you may become infertile as a result of treatment, and if so, what options you have to preserve your fertility. Learn all you can about the drugs you will be taking, during both primary and follow-up treatments.Your Fertility Preservation Options
There are several options for preserving your fertility. All of these methods have risks and benefits, and the procedure must be appropriate to your age and present fertility status. Some methods you may want to discuss with your doctor are:- Freezing fertilized eggs for in vitro fertilization (IVF)
- Freezing unfertilized eggs
- Ovarian tissue freezing
- Lupron (leuprolide) injections before and during chemo
- Freezing or banking sperm
How Soon After Treatment Is it Safe to Become Pregnant?
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Immediately after you finish treatment, you should spend time recovering your health. Pay attention to diet and exercise, and stick to your medication schedule. As for pregnancy, every diagnosis is unique, and so the decision and the timing of a future pregnancy should be discussed with your doctor. Most women are advised to wait from two to five years.
