How Breast Cancer Can Affect Fertility

Statistics shows that 1 in 29 South African women will be diagnosed with breast cancer in their lifetime. Of those diagnoses, the majority will be over 50 years of age who have passed their childbearing years. In 5 percent of new cases, women will be age 40 or under. For many of those women, it is crucial to understand their future family building options.
A cancer diagnosis is devastating and will turn your world upside-down. Winning the breast cancer battle only to find you are unable to conceive or carry a child opens the pages to an entirely new book of pain. And this pain can be avoided.

A breast cancer diagnosis does not mean you will be infertile.
The degree to which breast cancer affects fertility is dependent upon a variety of factors such as the type of breast cancer, the progression of the cancer, whether you will enter early menopause, and the type of cancer treatment prescribed. A discussion between your oncologist and reproductive specialist can better estimate what your fertility potential will be after cancer treatment. With both teams working on your behalf, your probability for future success is increased.

Fertility drugs are not linked with cancer.
Recent studies have confirmed that there is no link between breast cancer risk and fertility treatments. But increases in hormones can accelerate certain types of breast cancer. Infertility drugs and pregnancy can increase a woman’s hormone levels. If a hormone-sensitive tumour is present in the breast, there is a possibility that breast cancer growth will accelerate.

Cancer treatment can harm fertility potential.
When taking into consideration how cancer treatment will affect fertility, there are a number of different factors. Cancer type and age play a large role — some cancers are more aggressive than others and may be hormone-sensitive. As women, we are born with as many eggs as we will have in our lifetime. The resilience and health of eggs for a woman 39 years of age will not be the same when compared to a woman five years younger.

Treatment prescribed, be it surgery, chemotherapy or radiation, will determine how much damage the ovaries and reproductive organs will sustain. Delving further, the dose, type, duration, location and scope used for these methods will also affect whether or not treatment will impact fertility.

There are various techniques oncologists can use that can minimise the damage done to reproductive potential. Ovarian shielding can protect ovaries during radiation while ovarian suppression methods temporarily shut down ovaries.

After treatment, some women may retain their fertility potential. For others, menopause may arrive earlier in life, or even immediately after treatment. Taking into account, all of these factors can make it very difficult to predict whether a women’s eggs or reproductive organs will maintain function.

Fertility can be preserved in women
If you are planning on having a family after breast cancer treatment, there are several different options to preserve or protect your fertility.

Egg Freezing
Egg freezing can be roughly a 1-2 month process. However, with cancer patients the evaluation and treatment are done together to quickly freeze eggs and move on to cancer treatment immediately. First, patients must complete blood tests and ultrasounds to determine candidacy for egg freezing. Next, two weeks of medicine are taken to prepare the eggs and then an egg retrieval procedure is done. While you are on medicine, the growth of the eggs is monitored with ultrasound and blood tests to see when they will be ready. During the egg retrieval, you will be placed under light sedation and may feel a bit of cramping and bloating afterwards. The goal is to freeze somewhere around 10-15 eggs to optimise the chance of success later. Patients with hormone-sensitive breast cancer or breast cancer that has progressed may not be eligible for this form of fertility preservation.

Embryo Freezing
Should you already have a partner, this is the best option for future success. As you can imagine, eggs are extremely delicate and fragile and not all frozen eggs will survive the thawing process. You will need to undergo an egg retrieval after which your eggs will be fertilised with your partner’s sperm. The resulting embryos are frozen and can be used in the future for treatment. If carrying a baby in the future is not a possibility, a gestational carrier or surrogate is also an option.

Ovarian Tissue Freezing
While this is still an experimental procedure that is not widely available, ovarian tissue freezing is an exciting option for those looking to preserve fertility. Patients undergo a surgical procedure where part or all of an ovary is removed. The ovarian tissue containing immature eggs and hormone-producing cells is then cut into strips and cryopreserved. After a patient is cancer-free, the frozen ovarian tissue is thawed and transplanted back to the patient’s uterus. Even if this isn’t for three years, the frozen ovarian tissue will remain the same age as when it was cryopreserved.


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