This year, almost 290,000 American women will be affected by breast cancer, with 9% receiving their breast cancer diagnosis in their reproductive years. The question of suffering from fertility problems may pose a serious quality-of-life concern for this fraction of future breast cancer survivors. The interdisciplinary oncofertility team catering to such women not only considers the tremendous emotional distress they face due to the severity of the ailment and the suffering it entails but also has a solid understanding of both the reasons and therapies for infertility. This helps them to effectively develop strategies for fertility treatments and breast cancer treatments and balance the two to ensure that the malady is resolved and the woman is also capable of realizing her dream of having a baby.
Fertility Treatments and Breast Cancer: How the Disorder Affects Fertility in Women
Treatment strategies for breast cancer, like radiation, chemotherapy, and hormonal therapy affect fertility to a certain degree. Many young breast cancer survivors are facing treatment-related infertility issues. Amenorrhea (absence of menstruation) was reported in many women after breast cancer therapy, however, the number varies with age, type, and the overall dosage of chemotherapy received. The incidence of permanent stoppage of the menstrual cycle after therapy for breast cancer was between 33% to 76%.
A woman’s future fertility won’t be affected by treatment if they simply require surgery and no chemotherapy. Radiation can affect fertility in some cases. Chemotherapy, on the other hand, does entail infertility risks. Chemotherapy-treated breast cancer patients run the risk of experiencing earlier-than-usual menopause or premature ovarian failure.
Cyclophosphamide, a frequently recommended chemotherapy medication for the treatment of breast cancer, causes ovarian failure in about four out of every five women who are prescribed it.
A small tumor with few nodes that are confined and pose little risk of malignancy (widespread breast cancer cells) might not need systemic chemotherapy, in contrast to invasive breast cancer, which will most likely need a more comprehensive treatment protocol (i.e., systemic chemotherapy). Chemotherapy is used to treat cancers that are more advanced when they are first discovered, and thus have substantial chances of affecting the entire body.
Some breast cancers can also be treated with the use of hormonal treatments. However, a small number of breast cancer tumors are “hormonally insensitive,” – they do not have hormone receptors – leaving chemotherapy as the treatment of choice.
The right time to address the challenges of infertility caused by breast cancer treatment and strategies to combat this is before treatment, rather than after cancer therapy has begun. The discussion should include the entire healthcare team comprising of the physician, the oncologist, and the fertility expert. It is vital to share the information of all available methods to help the patient make an informed discussion. Also, women who have a family history of breast cancer or an increased risk of breast cancer (like those having a BRCA1 gene mutation) should regularly follow up with a fertility specialist to understand their options.
Methods of Fertility Preservation in Breast Cancer Patients
It is of utmost importance to ensure the quality of life of breast cancer survivors who are of childbearing age, to preserve their fertility. Egg and embryo freezing, cryopreservation of ovarian tissue, in vitro maturation, IVF treatment, and subsequent implantation of the embryo once cancer treatment is over are the fertility preservation options with the most conclusive scientific data and the greatest success rate. Fertility preservation and subsequent use of assisted reproductive technology is the best method since it is difficult to predict how the treatment will impact the woman’s fertility post-treatment.
Ovarian Suppression During Chemotherapy
In order to preserve ovarian function in patients who need chemotherapy, it is necessary to suppress ovulation so that chemotherapeutic agents do not cause harm to immature follicles. This can be done with the help of certain drugs. Chemotherapeutic drugs that destroy follicles involved in the maturation process affect the production and subsequent action of the follicle-stimulating hormone. The raised levels of FSH result in more follicles being produced and matured, making them susceptible to the side effects of the chemotherapy medication.
The injection of a medication that reverses the activity of follicle mobilization and maturation and prevents a rise in FSH concentration helps disrupt this cycle, thereby suppressing ovarian function.
Egg Freezing (Oocyte Cryopreservation)
Cryopreserved unfertilized eggs are another option for women to preserve their fertility. This is a good option for single women as a means of protecting future fertility. Oocytes are retrieved from patients during a hormone stimulation cycle using the same protocols as in conventional IVF, and they are then cryopreserved for use at a later time.
After the first evaluation of a breast cancer patient, the process of egg retrieval and cryopreservation should be started as soon as possible. This early clinical intervention for fertility preservation in young future survivors is vital to help them plan their families once the breast cancer treatment is done.
In Vitro Fertilization and Embryo Cryopreservation
Controlled ovarian stimulation (COS), which may be used with normal fertility drugs like clomiphene citrate, plus drugs like Tamoxifen or Letrozole (important since there is a significant increase in estrogen levels in women with breast cancer), can be used to induce egg production, then relying on natural cycles, since time is of the essence here. Studies have shown that Tamoxifen, when used for a brief period of time at a dosage of 40–60 mg per day, produces more developed oocytes and more reliably usable embryos than natural cycle retrievals.
Once the eggs are retrieved, they are mixed with a sperm sample from the husband (or from a donor, as the case may be) in the process of in vitro fertilization. The embryos thus formed are graded and the best ones are cryopreserved for future implantation.
With a 35%-40% likelihood of conception, embryo cryopreservation appears to be the most well-established fertility preservation method.
It should be noted that there is no evidence to support the fears that fertility drugs may cause breast cancer or increase the risk of breast cancer. The fertility drugs used today have been well studied and are extremely safe for the majority of women using them as part of their fertility treatment regimens when properly monitored by a fertility specialist.
The American Society of Clinical Oncology has emphasized the value of healthy survival and acknowledged the preservation of fertility as a crucial component post-treatment of breast cancer patients. For women of reproductive age who had not yet started planning or completed their families, breast cancer-induced fertility issues can cause great emotional upheaval leading to anxiety, crisis, and depleting psychological well-being. It has become vital, hence, to focus more on post-treatment survival, such as family planning, as a result of the increase in young women’s life expectancy brought about by advancements in breast cancer treatment, such as early detection and rigorous chemotherapy.
As therapies for breast cancer improve, a huge community of young survivors is emerging and thriving post-treatment, and onco-specialists must support these patients to enjoy their cancer-free future to the fullest. Through a greater knowledge of the causes of premature ovarian failure (POF) associated with cancer, cancer therapy as well as the creation and improvement of fertility preservation strategies, the promising field of oncofertility brings hope to young cancer patients and survivors.
At Dreams Fertility, we believe that every woman who is desirous of having a child, regardless of her current health status, is entitled to fulfill her dreams and we are committed to creating the best-customized plan for her to resolve any fertility-related issues she might be facing. Our thorough and deep understanding of how to use the advances in reproductive medicine and different fertility treatment strategies comes from working with thousands of women, each with a unique case.
In the case of women with breast cancer, we work closely with their oncology healthcare team to design an infertility treatment strategy, customized exclusively for them. We devise a personalized treatment that involves a combination of hormonal therapy as well as the above-mentioned clinical methods of fertility preservation to ensure that our patient realizes her dream of having her child.
To know more about how we can help in creating a fertility treatment and fertility preservation strategy for you, consult a schedule with a Dreams Fertility physician today.
Dr. Luis Murrain joined Dreams Fertility in 2021, providing specialty services in Fertility and Reproductive Genetics. With a shared vision that everyone deserves to have the family of their dreams, we are dedicated to helping all of our patients. We believe that families come in all shapes and sizes, and all of them are beautiful. We are proud to have a long history of providing services to all, including gay, lesbian, and transgender individuals and couples on their road to parenthood.