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Fertility

Many 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. 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.1

Losing the ability to have children can be a significant quality of life concern for women undergoing treatment for breast cancer. It’s important to have discussions with doctors as well as partners or spouses and ask about what options are available for your situation.

How does infertility occur with breast cancer treatment?

Chemotherapy agents, such as cyclophosphamide, fluorouracil, methotrexate, vinblastine, doxorubicin, and cisplatin, can cause temporary or permanent infertility, as the medications can damage the sex organs like ovaries in women and testes in men.2,4

Radiation therapy that is directed at the ovaries can also cause infertility in women. However, while radiation therapy is often used in breast cancer treatment, the ovaries generally do not experience significant effects from the radiation therapy used in breast cancer. Surgery to remove the ovaries – an oophorectomy – can also cause infertility as the eggs contained in the ovaries are removed.4,5

Certain hormone therapies used for hormone receptor-positive breast cancer can also potentially cause infertility, as they may temporarily or permanently induce menopause.4

What are ways to preserve fertility?

There are several ways to preserve fertility, but many of these options must be done before treatment for breast cancer begins. In some cases, it may not be safe for the individual to delay treatment.

Treatment options for preserving fertility in women include:6,7

  • 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.2

Questions to ask your doctor

Because many of the ways to preserve fertility should be done prior to beginning treatment for breast cancer, it’s important to have a discussion with your doctor. Questions to consider include:3

  • How serious is my condition?
  • What is my prognosis?
  • Before treatment begins, can we discuss fertility options?
  • What are my chances of getting pregnant after treatment?
  • Is it possible to delay treatment for a few weeks?
  • Is it possible for me to bank eggs?
  • Is it possible to freeze an ovary?
  • How long after treatment should I wait to get pregnant?
  • Could a future pregnancy increase the chances of breast cancer recurring?

Women wanting to undergo fertility preserving options should also discuss the financial aspect and check with their insurance about what options may be covered.

Written by: Emily Downward | Last reviewed: December 2018.
  1. 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 11/2/18.
  2. Fertility. Chemocare. Available at http://www.chemocare.com/chemotherapy/side-effects/fertility.aspx. Accessed 11/2/18.
  3. Fertility Issues. BreastCancer.org. Available at https://www.breastcancer.org/treatment/side_effects/fertility_issues. Accessed 11/2/18.
  4. Hulvat MC, Jeruss JS. Maintaining fertility in young women with breast cancer. Curr Treat Options Oncol. 2009;10(5-6):308-17.
  5. 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 11/2/18.
  6. 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.
  7. 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.