Breast cancer makes up approximately one-third of all cancers found in women of reproductive age, affecting thousands of women in this age group. Approximately 25% of all breast cancers occur in women before menopause, and 15% occur in women before the age of 45.1 Several of the treatments used for breast cancer can impact a woman’s fertility, or the ability to have children. While breast cancer in men is rare, treatment for breast cancer in men can also affect their ability to father children.
Though not everyone wants to have children, many people want to have the choice. Several of the options for preserving fertility must be done before treatment for breast cancer starts, and it is important for patients to discuss their options and the potential side effects of treatment with their doctor, including the impact on fertility, prior to beginning treatment.2
How breast cancer treatments can affect fertility
Some treatments for breast cancer may cause temporary infertility, while others may cause permanent infertility:
Chemotherapy may cause temporary or permanent infertility. In women who are closer to menopause, chemotherapy is more likely to induce menopause and cause permanent infertility. Chemotherapy can also cause infertility in men with breast cancer.3
Hormone therapy may cause temporary or permanent infertility as it can induce menopause. Some premenopausal women are still fertile after hormone therapy is done.4
Surgical removal of ovaries (oophorectomy) can cause a loss of fertility as the eggs contained in the ovaries are removed.5
Ways to preserve fertility before starting treatment
There are several ways to preserve fertility for women, including1,6:
Freezing eggs, which involves taking hormone injections for approximately 10 days to stimulate the ovaries and then retrieving the eggs under anesthesia. The removed mature eggs are stored for possible future use.
Freezing embryos, which also involves taking hormone injections for approximately 10 days to stimulate the ovaries and then retrieving the eggs under anesthesia. Next, the retrieved eggs are fertilized by a partner’s or donor’s sperm to create embryos. The embryos are frozen for possible future use. Freezing embryos is the option with the highest likelihood of success for female cancer survivors.
Ovarian tissue freezing is a procedure that can be performed on women who must begin treatment immediately and do not have the time to undergo hormone injections and egg retrieval. Part of an ovary or an entire ovary is removed under anesthesia and frozen for potential future use. Additional research is needed on this option, but a small number of pregnancies have resulted from re-implanting ovary tissue.
For men with breast cancer, the most common way to preserve fertility is sperm banking, also called cryopreservation. Semen is collected and frozen for later use. Most sperm banks recommend 3-6 donations collected over a two-week period, with at least 8 hours between each donation. As with other preservation options, this should be done prior to beginning treatment for breast cancer.3
Other options to have a family
In certain cases, action to preserve fertility may not be possible or may not be successful. However, there are many potential ways to have a family, including1:
Adopting a child
Using a donor egg or donor sperm
Using a donor embryo, which may be donated by couples who have previously undergone IVF for infertility
Using a surrogate
Sonmezer M, Oktay K. Fertility preservation in young women undergoing breast cancer therapy. The Oncologist. 2006;11(5):422-434. doi: 10.1634/theoncologist.11-5-422.
How cancer treatments affect fertility. The American Cancer Society. Available at https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/how-cancer-treatment-affects-fertility.html. Accessed 8/23/18.
Fertility. Chemocare. Available at http://www.chemocare.com/chemotherapy/side-effects/fertility.aspx. Accessed 8/23/18.
Fertility after hormone therapy. BreastCancer.org. Available at https://www.breastcancer.org/tips/fert_preg_adopt/treatments/hormonal. Accessed 8/23/18.
Rossi E. Oophorectomy for premenopausal breast cancer. Ob. Gyn. News, MD Edge. Available at https://www.mdedge.com/obgynnews/article/166317/breast-cancer/oophorectomy-premenopausal-breast-cancer. Accessed 8/23/18.
ISFP Practice Committee, Kim, S.S., Donnez, J. et al. J Assist Reprod Genet (2012) 29: 465. https://doi.org/10.1007/s10815-012-9786-y.