While older women are more likely to be diagnosed with breast cancer, each year in the U.S., around 9% of all breast cancer cases occur in women of childbearing age. The most common concern among such women is whether they can get pregnant after breast cancer. While breast cancer treatment does carry the risk of infertility in young women, particularly if gonadotoxic chemotherapy is administered, advances in assisted reproductive technologies have made it possible for breast cancer survivors to experience the joys of parenthood.
Can You Get Pregnant After Breast Cancer Treatment?
The general answer is yes. It means that it is possible. But you must understand that many therapies for cancer may negatively impact fertility in premenopausal women, so it is imperative to discuss this with your cancer care team. This is also where you need to bring your fertility specialist into the discussion, to devise a strategy to ensure that you can realize your dream of having children after you have beaten cancer.
With this in mind, let’s discuss how cancer treatment can affect your fertility and what your options are for increasing the chances that you can get pregnant in the future.
How Does Cancer Treatment Affect Fertility?
Cancer is the uncontrolled growth of cells. In breast cancer, the cells of the breast tissue become cancerous and, if left untreated, may metastasize (enter surrounding tissues) and cause life-threatening complications. However, if breast cancer is diagnosed early, it can have one of the best prognoses among different types of gynecologic cancers.
There are three treatment strategies – surgery, radiation, and chemotherapy. While surgery removes the cancerous tissue from the breast and radiation usually focuses on the breast tissue, they are targeted therapies that may not have any impact on the fertility of the women. However, chemotherapeutic agents are known to cause temporary, and in some cases permanent, loss of fertility.
Chemotherapy can induce infertility in premenopausal women. It may impair ovarian function, resulting in fewer and/or lower-quality eggs. Some cancer drugs linked with an increased risk of infertility in women are:
- Cytosine arabinoside
How likely you will have issues getting pregnant in the future depends on the medication in your treatment plan and how long you were undergoing treatment; as well as how old you are, and what your fertility status was before starting breast cancer treatment.
As mentioned before, if you are looking to have children in the future, it is vital to discuss the possibility of fertility preservation treatment with your breast cancer care team and involve a fertility specialist in the discussion. The timing is crucial because the oncologist’s priority will be to start treatment as soon as possible while cancer preservation techniques usually require some time of their own.
Fertility Preservation Options for Women Post Successful Breast Cancer Treatment
You may be able to choose from several fertility-preserving treatments before beginning treatment for breast cancer.
Cryopreservation, or the freezing of embryos, is a valuable technique for helping women maintain their fertility. First, the woman is put on ovulation-inducing (or ovary-stimulating) medication. This helps her ovaries to produce many mature eggs. Once ultrasound confirms the presence of multiple mature eggs in the ovaries, these eggs are then retrieved using a minor outpatient procedure.
These mature eggs are then mixed with a sperm sample (either from the partner or a sperm donor). The sperm fertilizes the eggs to produce embryos through a process called in vitro fertilization (IVF). IVF may also involve the injection of a single sperm into the egg using a technique called intra-cytoplasmic sperm injection (ICSI). The resulting embryos are frozen and stored until the completion of therapy. Once the woman is ready to get pregnant, the embryo(s) are thawed and if they survive, they are implanted into the woman’s uterus in an attempt to initiate a pregnancy.
Pregnancy probability increases with a woman’s age upon egg retrieval and decreases as menopause approaches or has already begun. The embryo’s quality is also an essential factor. Some embryos may not survive the thawing process; others may not implant into the uterus appropriately. Thus it is essential to have multiple embryos preserved, if possible.
Although embryo freezing has been around for quite some time, egg freezing has only been considered non-experimental since 2012. In the absence of a male partner, a refusal to use donor sperm to create a fertilized embryo, or a moral or religious objection to the practice of embryo freezing, this option may be appealing to women.
After removing mature eggs from the woman’s ovaries, they are frozen until they can be fertilized with sperm. This method is also called egg banking. When the woman is ready to get pregnant, the eggs can then be thawed, fertilized by a partner’s or donor sperm, and the embryo implanted in her uterus to achieve pregnancy.
Ovarian Tissue Freezing
This method is still considered experimental. However, there have been many instances of its successful use. It includes all or part of one ovary being removed through laparoscopy. During this laparoscopic operation, a thin, flexible tube is introduced through a tiny cut near the belly button to reach and see into the pelvis. It is common practice to strip the ovary, freeze the strips, and preserve them for later use. Tissue from the ovary, once frozen, can be transferred to the pelvis following cancer therapy (transplanted). Eggs can be retrieved and efforts at in vitro fertilization can be made after the transplanted tissue begins to function again.
The Natural Way
It’s also possible, especially if you’re young, to try to conceive a child the natural way. Once you have successfully completed your cancer treatment, your fertility specialist will assess your fertility levels. You may either require some assistance in the form of medication or none at all, depending upon your unique physiology. Experts recommend a gap of around two years post-treatment. However, this is not a standard recommendation and you will need to consult your doctor before continuing.
In the practice of surrogacy, also known as third-party reproduction, a woman gives her informed agreement to carry a pregnancy for one or more intended parents who may not be able to carry a pregnancy due to a medical condition. Surrogacy is an option if you’ve either frozen your eggs or embryos and after completion of treatment, are unable to carry a pregnancy to term due to medical reasons.
How Long Should I Wait to Get Pregnant After Completing Breast Cancer Treatment?
Women who have successfully beaten breast cancer and want to start a family are often advised to wait at least two years after finishing treatment before attempting to get pregnant. Cancer treatment has different impacts on the body and the body needs time to heal and repair itself from these after-effects of treatment. For instance, the heart has an increased workload throughout pregnancy and childbirth. In some cases, radiation treatment to the upper abdomen or chest may be used with anthracycline chemotherapy. Having both of these factors together raises the danger of cardiovascular issues.
Although 2 years is typically considered long enough to detect cancer’s early recurrence and to repair any mutations that may have occurred due to radiation and chemotherapy, each case is different, and you should consult your oncofertility team for guidance on when you can start planning for pregnancy. Considerations such as age, the likelihood of an early cancer recurrence, the type of breast cancer you were diagnosed with, and the type of treatment are all important.
Genetic Screening for Cancer
Genetic testing for cancer risk can be done if you have a history of cancer in your family. This genetic screening can detect if you are at a higher risk to develop cancer at some point in your life. Genetic testing may help:
- Predict your risk of a particular disease
- Find if you have genes that may pass increased cancer risk to your children
- Provide information to guide your healthcare
No genetic test can say if you will develop cancer for sure. But it can tell you if you have a higher risk than most people. Only some people with a gene mutation will develop cancer. What does this mean? A woman may have a 45% to 65% chance of breast cancer. But she may never develop the disease. Meanwhile, a woman with a 25% chance may develop breast cancer.
What Are the Cancer-related Risks to Me and My Child?
Although you’ve beaten breast cancer, there is always this nagging fear of it either coming back or causing issues in the child. Concern about your child’s health is a common source of stress for parents battling cancer. However, it is heartening to note that there is no increased risk of cancer in the offspring of cancer patients or survivors and the pregnancy outcomes are generally positive. However, a few types of cancer can be passed on from parents to children. Individuals with a family history of the disease are at a higher risk.
Pregnancy does not appear to increase the risk of breast cancer recurrence. Certain pregnancy-related hormones have been linked to the amplification of breast cancer cells. However, there is no evidence that a woman’s cancer risk rises if she becomes pregnant within two years of finishing therapy. Recurrences of breast cancer may be less likely with subsequent pregnancies.
To get pregnant, some survivors may need to get off of particular drugs. However, the chance of cancer returning increases if treatment with drugs like tamoxifen or imatinib (Gleevec) is discontinued. Those who choose to start a family should discuss the level of risk they are willing to take. Before attempting to conceive after cancer treatment, consult your healthcare team and a fertility expert.
Trust Dreams to Help You Conceive After Beating Cancer
At Dreams Fertility, we have worked with many breast cancer patients and survivors to help them realize their dream of having children. We understand the sensitivity of the matter when a woman gets a positive breast cancer diagnosis and the emotional toll it may take on the entire family. However, with advances in cancer research, breast cancer usually offers a good prognosis and better overall survival rates, and many women, especially young breast cancer survivors, do win the battle. The Dreams Fertility team has the job of helping preserve the fertility of the woman so that she can experience the joy of parenting.
As an expert team of fertility specialists, we work closely with your oncology team to ensure the best possible options for preserving your fertility. And when you have successfully completed your treatment and are ready to start a family, we will devise a customized fertility program for you that will help you achieve pregnancy.
To know more about your fertility preservation options and our customized fertility plans, schedule a consult 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.