Many young adults with breast cancer wonder how cancer and its treatment will affect their fertility (ability to become pregnant).
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Considering pregnancy after a breast cancer diagnosis can be very difficult for patients and their loved ones. If you decide to try to get pregnant, it may be harder after breast cancer treatment than it otherwise would have been. If you think you might want to get pregnant after your treatment is done, you should learn more and talk with your doctor, a fertility expert, a social worker, or another counselor.
Safety
Is it safe for me to become pregnant after breast cancer? Yes, we believe it is safe. Studies show that your chances of breast cancer recurrence or of dying from breast cancer do not increase if you become pregnant after your treatment. However, studies are limited and some experts remain concerned. People with a history of breast cancer continue to be at risk of recurrence both during and after a pregnancy. (Recurrence means breast cancer returning to the breast area or other parts of the body.) Is it safe for my future child if I become pregnant after breast cancer? Yes. Your history of breast cancer treatment should not increase the risk of birth defects in your future child(ren). This is true as long as treatment medications have been out of your system for enough time (3 months for tamoxifen; 7 months for Herceptin). We strongly recommend that you avoid getting pregnant while undergoing chemotherapy and/or hormonal therapy (like tamoxifen). Both can cause birth defects to a fetus (unborn child), especially during the first trimester. To avoid pregnancy, be sure to use contraception methods that are considered safe for young adults with breast cancer (such as non-hormonal methods like condoms or a copper IUD), if necessary for your kind of cancer. Learn more about contraception. |
Highlighted Webcast:Can I Have a Baby After Breast Cancer? If So, When? Ann Partridge, MD, MPH discusses pregnancy after breast cancer with a panel of other specialists and patients in the Young and Strong Program. |
Treatment Considerations
Each person's situation is different, so consider how proactive you want to be about protecting your fertility as you go through treatment. The two main treatment options for young adults with breast cancer are hormonal therapy and chemotherapy.
Each person's situation is different, so consider how proactive you want to be about protecting your fertility as you go through treatment. The two main treatment options for young adults with breast cancer are hormonal therapy and chemotherapy.
Hormonal therapy
Hormonal therapies, such as tamoxifen, do not damage the ovaries, although they can make your periods irregular. However, over the standard 5 to 10 years of treatment that are often recommended, your fertility will decrease naturally. For example, if you are diagnosed at age 30, you will be less fertile at 35, with or without hormone therapy.
Some people decide to stop hormonal therapy so they can try to become pregnant. This may reduce the potential benefits of completing the treatment. Researchers are studying this, and preliminary results of the POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for Women with Endocrine Response Breast Cancer) trial are described in this video. Be sure to talk with your doctor to weigh the benefits and risks before stopping hormonal therapy.
Hormonal therapies, such as tamoxifen, do not damage the ovaries, although they can make your periods irregular. However, over the standard 5 to 10 years of treatment that are often recommended, your fertility will decrease naturally. For example, if you are diagnosed at age 30, you will be less fertile at 35, with or without hormone therapy.
Some people decide to stop hormonal therapy so they can try to become pregnant. This may reduce the potential benefits of completing the treatment. Researchers are studying this, and preliminary results of the POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for Women with Endocrine Response Breast Cancer) trial are described in this video. Be sure to talk with your doctor to weigh the benefits and risks before stopping hormonal therapy.
Chemotherapy
Chemotherapy does damage the ovaries directly and reduces fertility. Some types are more damaging than others. While some people continue to have regular cycles throughout chemotherapy treatment, many may experience amenorrhea —when menstrual periods stop temporarily—or menopause, when periods stop permanently. Sometimes periods restart when chemotherapy ends, especially in adults 40 or younger. Sometimes they do not re-start. The older you are, the more likely you are to experience full menopause and/or infertility after chemotherapy. Learn about menopause and menopausal symptoms.
Most current studies show a strong relationship between long-term amenorrhea and infertility (not being able to get pregnant). However, if a person has amenorrhea after cancer treatment, it does not necessarily mean they are infertile. On the other hand, if a person does have menstrual periods after breast cancer treatment, their ovaries might still be damaged, and they may be infertile.
A fertility specialist can do tests to see if you are likely to be able to get pregnant or not. Talk with your doctor about your cancer, the best treatment options, and what fertility means to you.
Chemotherapy does damage the ovaries directly and reduces fertility. Some types are more damaging than others. While some people continue to have regular cycles throughout chemotherapy treatment, many may experience amenorrhea —when menstrual periods stop temporarily—or menopause, when periods stop permanently. Sometimes periods restart when chemotherapy ends, especially in adults 40 or younger. Sometimes they do not re-start. The older you are, the more likely you are to experience full menopause and/or infertility after chemotherapy. Learn about menopause and menopausal symptoms.
Most current studies show a strong relationship between long-term amenorrhea and infertility (not being able to get pregnant). However, if a person has amenorrhea after cancer treatment, it does not necessarily mean they are infertile. On the other hand, if a person does have menstrual periods after breast cancer treatment, their ovaries might still be damaged, and they may be infertile.
A fertility specialist can do tests to see if you are likely to be able to get pregnant or not. Talk with your doctor about your cancer, the best treatment options, and what fertility means to you.
Protecting Fertility
Talk with your doctor if you think you might want to become pregnant in the future. Some fertility procedures may require you to make decisions and take action fairly quickly to avoid delays in your cancer treatment. Decide if you want to see a fertility specialist soon or if you want to wait and think more about your options.
Some procedures may increase your ability to have a future pregnancy. However, they may also pose risks. Some may not be covered by insurance or be available where you live, but fertility treatment providers will be able to help you with resources. No method guarantees pregnancy, but one or more approaches may be right for you. Talk with your doctor and a fertility specialist to make a plan.
Talk with your doctor if you think you might want to become pregnant in the future. Some fertility procedures may require you to make decisions and take action fairly quickly to avoid delays in your cancer treatment. Decide if you want to see a fertility specialist soon or if you want to wait and think more about your options.
Some procedures may increase your ability to have a future pregnancy. However, they may also pose risks. Some may not be covered by insurance or be available where you live, but fertility treatment providers will be able to help you with resources. No method guarantees pregnancy, but one or more approaches may be right for you. Talk with your doctor and a fertility specialist to make a plan.
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The PDF below links to a table that shows a number of methods for protecting fertility, both during and beyond breast cancer treatment. The document was adapted with permission from FertileHOPE.
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Your Reproductive Options
Reproductive medicine offers a variety of procedures that can help you protect your fertility before, during, and after breast cancer treatment. Some of them may fit your needs better than others. It's important to speak with your doctor and a fertility specialist to develop a plan that makes sense for you and your family. Other ways to bring a child into your life after breast cancer include adoption or foster care.
Cryopreservation
Reproductive procedures that involve freezing are called cryopreservation (cry-oh-prez-er-vay-shun). This can be done in a variety of ways:
Medical ovarian suppression
Hormone shots during your cancer treatment can shut down your ovaries to help protect them from chemotherapy damage. Recent studies suggest it may preserve periods and fertility. Talk to your doctor if you are interested in this.
Donor options
Reproductive help from outside sources includes the donation of eggs, sperm, or fertilized embryos. The most common options for a young adults with breast cancer are donor eggs or donor embryos.
Other options
Other options for bringing a child into your life after breast cancer include: adoption (domestic or international) adoption from within the foster care system sponsoring foster children.
For information about fertility preservation services, visit Brigham and Women’s Hospital’s Center for Infertility and Reproductive Surgery.
Cryopreservation
Reproductive procedures that involve freezing are called cryopreservation (cry-oh-prez-er-vay-shun). This can be done in a variety of ways:
- Freezing a fertilized egg (also called embryo freezing)
A fertility doctor gives you hormones to make your ovaries produce lots of eggs. The unfertilized eggs are removed from your body and fertilized with sperm (from a partner or a donor). Fertilized eggs are frozen and stored for later use.
- Freezing an unfertilized egg
A fertility doctor gives you hormones to make your ovaries produce lots of eggs. The unfertilized eggs are removed from your body, frozen, and stored for later use. After your breast cancer treatment is over, the eggs can be thawed and fertilized with sperm. This method is now nearly as successful as embryo freezing. Especially if you don’t have a partner now and don’t want to use a sperm donor, this may be the right option for you. - Freezing ovarian tissue
Before your cancer treatment begins, a piece of your ovary is removed and frozen. This helps protect the tissue from damage during chemotherapy. Once your treatment is done and you are ready to try to get pregnant, the tissue is put back in your body. Note: Many fewer pregnancies have resulted from frozen ovarian tissue than from frozen embryos or eggs. This procedure is only performed if there is not enough time to freeze eggs or embryos.
Medical ovarian suppression
Hormone shots during your cancer treatment can shut down your ovaries to help protect them from chemotherapy damage. Recent studies suggest it may preserve periods and fertility. Talk to your doctor if you are interested in this.
Donor options
Reproductive help from outside sources includes the donation of eggs, sperm, or fertilized embryos. The most common options for a young adults with breast cancer are donor eggs or donor embryos.
- Donor eggs or oocytes (oh-oh-sites)
After you finish your breast cancer treatment, you can use eggs donated by another adult if you have become infertile. These eggs are fertilized with sperm (from a partner or a donor). The resulting embryo is put into your uterus.
- Donor embryos
After you finish your breast cancer treatment, you can use a fertilized embryo from an egg donor and a sperm donor if you are infertile. The donated embryo is put into your uterus.
Other options
Other options for bringing a child into your life after breast cancer include: adoption (domestic or international) adoption from within the foster care system sponsoring foster children.
For information about fertility preservation services, visit Brigham and Women’s Hospital’s Center for Infertility and Reproductive Surgery.
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Grief and acceptance
Fertility after breast cancer can be a very difficult issue. Perhaps you were planning to have a child soon. Maybe you've been told to wait or that pregnancy may not be possible in the future. Dealing with this potential loss can lead to intense emotions, like sadness and anger. It may take time to adjust and accept your situation, but be patient with yourself. Getting good, clear information and a realistic sense of what may or may not be possible often helps. Speak to your provider about your concerns. Find a counselor, a therapist, or others who have been through this process. For guidance around grieving and related resources, talk to a social worker at Dana-Farber. |
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External Resources
LIVESTRONG
Fertility Information (English and Spanish) and a fertility discount program (for U.S. citizens and permanent residents) for cancer patients and survivors whose treatments may reduce fertility or cause infertility. |
My Oncofertility
A patient education website created and sponsored by fertility researchers and scientists at Michigan State University. |