How Breast Cancer Affects Fertility
You’re a young woman, just diagnosed with breast cancer. Will treatment affect your fertility? Will you ever be able to have children? Find out what breast cancer and its treatment may mean to your future as a mom.
Q. I’m 32 years old, and have just found out I have breast cancer. I’m engaged to be married, and we’d planned on having kids right away. Am I still going to be able to get pregnant? Help!
A. OK, your first move is to stay calm and focused. Cancer treatment may not impair your ability to become pregnant, once you’ve finished treatment. If your cancer is very early, and will be treated only with a lumpectomy and radiation followed by tamoxifen, then there’s every chance you can still have children “the normal way” – someday. (Tamoxifen can damage a developing fetus, so you’d need to postpone pregnancy till after you’d finished taking it.)
On the other hand, if you’re going to need chemotherapy, there’s a possibility that you’ll have to resort to non-standard methods of becoming pregnant: e.g., in-vitro fertilization. Unfortunately, one of the most common chemo drugs used to treat breast cancer, Cytoxan, is particularly toxic to the ovaries and your stored eggs. So having chemo can make you infertile.
Ask to be assigned to an oncologist ASAP, and let him/her know you want to become pregnant after treatment. It’s important that you make a possible plan quickly, even before surgery; if your pathology report post-surgery reveals that you’ll need chemo, the clock will be ticking for you to harvest eggs for future use prior to chemo – a process that can take up to 6 weeks.
Q. Assuming I’ll need chemo, what do I need to do right now?
A. Chemo can affect your fertility temporarily, or permanently; it all depends on your age and the type of chemo. The younger you are, the more eggs you still have and the more viable they are. You’ll stop having your period during chemo, but afterwards, if the chemo wasn’t overly toxic to your ovaries, you should resume ovulating, and should still have a good supply of healthy eggs.
On the other hand, certain types of chemo can destroy all of your eggs. And for women who are older, even less-toxic chemo can destroy enough eggs to stop periods permanently.
To prepare for any possibility, it’s good to look into harvesting healthy eggs prior to chemo, so they can be stored for future use.
Q. How do I begin this process?
A. You’ll want to be referred to a reproductive endocrinologist, who can explore various options with you.
The easiest course, though not the most successful, is to harvest and freeze unfertilized eggs. Unfortunately, unfertilized eggs don’t keep well; freezing tends to damage them, so your chance of having a healthy baby using a stored unfertilized egg is slim, at this point.
Women see much more success with in-vitro fertilization, where eggs are harvested and immediately combined with sperm to fertilize them. They’re then frozen, and will be ready to implant into your uterus once you’re completely through treatment. Currently, up to 32% of women undergoing IVF will have a healthy baby.
The main issue with in-vitro fertilization is cost. At $10,000 to $15,000 per attempt (eggs being harvested, fertilized, and stored), it’s expensive. And many insurance companies won’t cover it. So understand the financial implications before you get too far down the road.
Another issue is the legal question of who “owns” the fertilized eggs, and who can decide what to do with them. You and your fiancé might decide on joint custody; but what if he bails on you during treatment, and afterwards says he doesn’t want to be a father? Historically, courts of law have upheld a person’s desire to NOT be a parent, and this would prevent you from using those fertilized eggs.
Just to be safe, you might decide on an anonymous sperm donor. But assuming you and your fiancé do get married, what kind of emotional issues might this cause going forward?
To be safe, you’ll want to consult an attorney who specializes in reproductive law if you decide to pursue IVF.
Q. Wow… I can’t believe I have to consider so many other things while I’m still trying to absorb the fact that I have cancer. I’m feeling really panicky…
A. And that’s exactly why you need to act quickly. Establish who your oncologist will be. Tell him/her pregnancy post-treatment is a goal. If s/he seems uncertain or unwilling to help you plan for a future as a mom, ask for another oncologist immediately, preferably one who’s dealt with younger cancer patients.
Also, and this is a tough one, have a heart-to-heart with your fiancé about this. Tell him cancer treatment may be rough, and having children has just become more challenging than you thought. Establishing, to the best of your ability, that he’s totally committed – to you, and to the issues you may encounter post-cancer – is a huge plus.
At this point, you can’t know exactly what you may need to do to preserve your ability to become a mother. Fear of the unknown is a huge stressor; so exploring all your options, and understanding the implications of each, should make you feel better.
Finally, not being able to bear your own children doesn’t mean you can’t be a mom. Adoption has been a great path for many women whose cancer treatment has caused infertility. So start thinking how you’d feel about parenting an adopted child; after all, a mother’s love comes from the heart, not the ovaries.
For more information, check out the following Web sites:
Fertilehope.org, run by the Lance Armstrong Foundation, offers reproductive information and support to cancer patients whose treatments may impair their ability to become biological parents.
Myoncofertility.org is a patient resource developed and funded by the Oncofertility Consortium, a joint venture of Northwestern University and the National Institutes of Health (NIH).