Being diagnosed with breast cancer can be so overwhelming, that it can be all-too easy for a woman to lose sight of life beyond their upcoming battle. But the truth is, women who undergo chemotherapy can experience changes in their fertility that may impact their chances of getting pregnant after their cancer has been treated. For instance, some women may experience chemotherapy-induced amenorrhea (the absence of a menstrual period), premature menopause, or even infertility.
Tamoxifen is a popular chemotherapy drug used to treat all stages of hormone receptor-positive breast cancer, but it shouldn’t be the drug of choice for all women. In particular, women who are pregnant, think they are pregnant, or are planning to become pregnant should avoid using Tamoxifen due to its ability to cross the placental barrier and its increased risk of causing fetotoxicity.
While some women may be able to get pregnant naturally after their cancer treatment ends, others may find they are unable to have children after treatment. But regardless of the case, being diagnosed with breast cancer means that you will have to think about your fertility earlier than you might have originally planned if you wanted to have a child at some point in the future.
Whether you choose to have your embryos or eggs frozen, fertility stimulation is your first step in preserving your ability to get pregnant after chemotherapy. Your doctor will prescribe certain hormones to help stimulate egg production. A common option is an aromatase inhibitor called Letrozole. Letrozole is effective at increasing egg production, thus giving women more eggs to have removed and fertilized and/or frozen. It is now the drug of choice over Clomid because it produces fewer side effects and recent research suggests it may result in higher ovulation and pregnancy rates.
Understandably, cost is one of the biggest concerns about preserving one’s fertility, but it is even more of a concern when you are already preparing for chemotherapy treatment and adapting to the lifestyle changes breast cancer forces on you. The cost varies by city and state, so we have done our best to provide you with an average cost estimate, so you can plan accordingly.
I personally went through three rounds of IVF in my early thirties, so I have a deep understanding of the emotional rollercoaster that often comes with the fertility journey. I have such compassion and empathy for any woman facing the challenges involved with trying to have a family. I believe it is so important for a woman who is facing a breast cancer diagnosis to be empowered, and this begins by having a better understanding of all her fertility options, being prepared, and knowing more about the impact this can have on planning a family.
Allison DiPasquale, MD
Breast Surgical Oncologist
Texas Oncology
“I am beyond honored to join the rockstar team of medical advisors at LLL. In a world of readily available information on the internet this company is the absolute best that I have seen to get the correct, physician vetted information directly into your hands. Wherever you are on your journey, LLL can be the ultimate source of information to help you gain knowledge and support as well as meet others just like you.”
“No matter what your ovarian function or reproductive abilities, please believe me when I tell you that you are not broken, and you never were. You and your body have been through so much, and you are still overcoming the challenges before you. You are beautiful in every way and your fertility will never be a measure of the space you keep and the woman you are. A woman’s worth cannot be measured by her reproductive abilities.”
-Mindy, Stage 2- Emotional Contributor
IG : @msmindymiller
Knowing how cancer might affect your fertility is therefore an important thing to discuss with your treatment team before you start on your journey to recovery. Research shows that changes in fertility can not only be affected by your age, but also by which chemotherapy drugs are being used to treat your cancer and the dosage of the drugs.
While most premenopausal women will usually temporarily stop menstruating during or following chemotherapy, those younger than 35 tend to be less likely to develop treatment-related menopause. Most will regain healthy ovarian function within a few years after chemotherapy and some even get pregnant while not menstruating.
Meanwhile, women who are diagnosed with breast cancer and receive chemotherapy at 40 or older are more likely to remain in menopause after chemotherapy ends. If you are already close to menopause age, typically around 51 years old, and undergo chemo for breast cancer, then most likely you will enter menopause and not be able to conceive after treatment.
Fetotoxicity is a process by which the fetus is poisoned by a medication. When this occurs, it can compromise maternal health and result in fetal malformations, altered growth, and even in utero death. As a result, Tamoxifen should only be used during pregnancy when the benefits of the drug clearly and significantly outweigh the risks to the unborn child.
If you are premenopausal and always wanted a child or are unsure but still want the option to choose, then it is important to talk to your doctor about your fertility options before your cancer treatment begins. Your team will help you find a balance between treating your cancer and having the ability to have children. Today, there are several options open to women who want to preserve their fertility when diagnosed with breast cancer, including freezing embryos for IVF, freezing eggs, and freezing ovarian tissues.
Freezing embryos for IVF is the most effective way of preserving fertility. This process involves taking hormones to stimulate your ovaries to make eggs. A doctor then removes the eggs and fertilizes them with the donor’s sperm (if you don’t have a male partner at this stage) to create an embryo which is then frozen and stored. The biggest disadvantage of choosing this process is that it takes time, and this could result in a delay to receiving your cancer treatment.
Freezing eggs is a quicker way to preserve your fertility because it doesn’t require fertilization. You will take hormones to stimulate egg growth and then the doctor will remove the eggs and freeze them. When you are ready to become pregnant, the eggs are thawed and injected with the donor’s sperm to fertilize them. The biggest disadvantage with this process is that the freezing and thawing process can sometimes damage the eggs, resulting in an unsuccessful pregnancy.
Freezing ovarian tissues is a newer fertility option that is still in development. Also called ovarian tissue cryopreservation, this process involves surgically removing ovarian tissue and then freezing it. After the cancer treatment is finished, the tissue is put back.
Another option to stimulate fertility is using a class of medication called gonadotropins. Common names for this type of drug can include Follistim, Menopur, Bravelle, or Gonal-F. Gonadotropins contain an active form of the FSH, which is the main hormone that is responsible for producing mature eggs in the ovaries and they have been shown to be often capable of inducing ovulation in women who have not had success with Clomid or Letrozole. Another benefit of using gonadotropins is that they can regulate the menstrual cycle, which means that ovulation can be predicted more precisely.
Average IVF treatment costs:
Average IVF with egg donation treatment costs:
Average IVF with embryo donation treatment costs:
Average IVF with sperm donation treatment costs:
It is important to note that these costs are in addition to the costs associated with freezing your embryos or eggs, which averages $7,500.
I personally went through three rounds of IVF in my early thirties, so I have a deep understanding of the emotional rollercoaster that often comes with the fertility journey. I have such compassion and empathy for any woman facing the challenges involved with trying to have a family. I believe it is so important for a woman who is facing a breast cancer diagnosis to be empowered, and this begins by having a better understanding of all her fertility options, being prepared, and knowing more about the impact this can have on planning a family.