Fertility after Cancer
For young women who are diagnosed with breast cancer (or another cancer), concerns about future fertility are usually very important. While it is relatively simple to help young men preserve the possibility of fathering children (sperm banking), it is more complicated for women. Until fairly recently, at least at my hospital, women with breast cancer were generally not encouraged, if not actively discouraged, from considering egg preservation before starting treatment. There were concerns about delay, but also about the hormones that were used to stimulate egg growth as part of the harvesting process. There are now alternative methods that seem to minimize or eliminate these worries. It is, however, still a big undertaking, and most young women whom I have known have decided against it. Another factor is financial as it is far from certain that insurance will cover this process, and the bill can easily then be thousands of dollars.
Important comment: I know quite a few women who have gone on to have healthy pregnancies and healthy babies after breast cancer. It is possible.
This is an article from Catherine Lee, MD and her colleagues at the Moffitt Cancer Center in Tampa about these issues. Here is the introduction and then a link to read more:
Fertility and Reproductive Considerations in Premenopausal Patients With Breast Cancer
M. Catherine Lee, MD, Jhanelle Gray, MD, Hyo Sook Han, MD, and Shayne Plosker, MD
Background: Approximately 10% of all new breast cancer diagnoses occur in young women. Although lacking medical comorbidities, these patients often have unique issues with regard to their reproductive health that merit special consideration. As breast cancer outcomes continue to improve, quality of life for patients and their families after breast cancer treatment has come to the forefront of cancer research, particularly in the
growing field of oncofertility.
Methods: This article reviews the literature on the singular situations and controversies faced by premenopausal breast cancer patients.
Results: Data on amenorrhea and the effects of modern chemotherapeutic agents on amenorrhea are limited, although the role of tamoxifen in amenorrhea is more clearly defined as increasing the rate of amenorrhea across several studies. At the forefront of studies on fertility and premenopausal breast cancer patients are investigations on fertility preservation via ovarian protection and on assisted reproductive technologies. The
use of gonadotropin-releasing hormone analogs for ovarian protection remains controversial and continues to be investigated.
Conclusions: Early integration of assessment and counseling regarding fertility preservation is part of the multidisciplinary approach in the care of the premenopausal breast cancer patient and is key to optimizing both cancer treatment and fertility plans for the future. Because of the many ongoing biological, practical, and ethical controversies surrounding oncofertility, eligible patients should be strongly encouraged to participate in
clinical trials and studies to further increase our knowledge in this growing field.