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Breast Cancer and Fertility

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As breast cancer survival rates improve, quality of life becomes increasingly important. For young women diagnosed with breast cancer, a major concern on their minds may be what effect the cancer or treatment will have on their fertility. The increasing use of chemotherapy for breast cancer has implications in the physical and psychological state of women, so it is important for women to know what risks and options they have.



Female germ cells (oocytes) give rise to the gamete (ovum/egg) that comes together with the male gamete (sperm) during fertilization. The female germ cells proliferate before birth and stop at a certain stage of the growth cycle. A female is born with about 1 million oocytes -- all the eggs she will ever have in her life. By puberty the number has reduced to about 300,000 and with each menstrual cycle there is further loss.[1]



Chemotherapy can cause temporary or permanent amenorrhea (lack of a menstrual period) due to an increased loss of oocytes. If the number of viable cells falls below a critical number, ovarian failure can occur. Essentially, a woman goes into early menopause and becomes unable to have children anymore. Even if a woman continues having normal menstrual cycles after chemotherapy, fertility may still be impaired and menopause may start earlier than it normally would have. Women with breast cancer are less likely to get pregnant compared to other women, but it is unclear whether this is due to direct effects, natural changes with advancing age, or a change in attitude.


In general, chemotherapy for breast cancer appears to "age" reproductive function by about 10 years.

Despite this, one nationwide study has shown that there is no direct risk of adverse birth outcomes for women with breast cancer. This includes prematurity, low birth weight, stillbirth, and congenital abnormalities. A history of breast cancer also does not mean that breastfeeding is off limits, as there is no proof of increased risk of cancer in infants who are breastfed by mothers with a history of or current breast cancer.[2]



The risk of temporary or permanent menopause after chemo depends on several factors. Most studied so far is the type and dose of drug used. As a general rule, alkylating agents are more likely to induce amenorrhea than anthracyclines or antimetabolites. Studies show that the "CMF regimen" (cyclophosphamide, methotrexate, and 5-fluorouracil) leads to amenorrhea in 21-71% of women under 40 years of age; the rates are even higher in older women.[2] However, this combination is not commonly used anymore. Anthracycline-based chemotherapy regimens have lower incidences of amenorrhea due to lower dose of cyclophosphamide.




It is important to remember that breast cancer doesn’t necessarily mean the end of the road. There are options available for women who wish to protect their fertility before getting treatment for breast cancer in case their fertility is affected by the chemotherapy. Among these options include embryo cryopreservation and Luteinizing Hormone-Releasing Hormone (LHRH) agonist to protect the ovaries. These methods are still being investigated, but they offer hope to young women who wish to keep their options open.


Stephanie Wu BS, Shikha Jain MD




[1] Jones AL. Fertility and pregnancy after breast cancer. The Breast. 2006;15(S2):S41-S46.

[2] Hickey M et al. Breast cancer in young women and its impact on reproductive function. Human Reproduction Update. 2009;15(3):323-339.



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