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Home What is Breast Cancer Breast cancer and Pregnancy How will Chemotherapy affect my ability to have children in the future?

How will Chemotherapy affect my ability to have children in the future?

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A diagnosis of breast cancer can be difficult to deal with, but as a potentially curable disease, it can sometimes be important to consider your life goals after treatment. If having children in the future is among your considerations, there are several issues to consider. Speaking with your doctor regarding this issue and incorporating it in the decision-making process is key to ensuring your chances of success. Chemotherapy can produce gonadal (reproductive system) dysfunction in both men and women [1]. In women, loss of ovarian function can be either temporary or it can be permanent[2]. The severity of dysfunction is dependent upon the exact chemotherapy agents used, the total doses administered, and the patient's age; the risk of permanent ovarian failure increases with age. Literature reports have shown that with a common chemotherapy regimen for breast cancer, menstrual cycles resumed in 50% percent of women younger than 40, but in only 10% of those over the age of 40 [3].

So what can be done to preserve fertility in patients who are to undergo chemotherapy? There are several options available at this time, though some may still be considered investigational or not well-established. Cryopreservation of embryos is a well-established method for preserving fertility [4], in which oocytes are retrieved prior to chemotherapy, then undergo in-vitro fertilization and the resulting embryos are preserved cryogenically until the patient is ready to undergo implantation. This method, however, has limitations due the fact adequate time for ovulation induction and oocyte retrieval is needed; moreover, a partner who is willing to donate sperm or an anonymous donor is also required. Cryopreservation of oocytes is an investigational technique that removes the need for donor sperm but has a disadvantage in that oocytes are more susceptible to injury during crypreservation [5]. Another technique that uses cryopreservation is a one in which ovarian tissue is preserved. This tissue can then be implanted at a future time and oocytes can be retrieved [6], but this technique is also still investigational. Finally, another approach being investigated is based on the theory that ovarian toxicity from chemotherapy can be reduced by slowing ovarian function during the period of active treatment; however at present, there is no convincing data that shows this method to be an effective means of fertility preservation [7].

The timing of pregnancy after chemotherapy is also an important consideration. It is generally recommended that 2 years are allowed to pass after treatment; this is to ensure that the cancer does not recur in the meantime. For those who do become pregnant, it is reassuring to know that in our experience with survivors of childhood cancers, the available data do not support an adverse effect of prior chemotherapy on the risk of miscarriage, fetal death, or birth weight [8].

Finally, if fertility is not preserved, there are still options to consider. Using donor oocytes for in-vitro fertilization is one option and adoption is another. The ability to call a child your own, and the bond you build through childrearing and experiencing life’s wonders together are both priceless and precious, regardless of whether or not the child shares your DNA.

Motherhood can be important in some women’s concept of fulfillment, and although a diagnosis of breast cancer can set hurdles to this goal, it is important to know that there are options available. Again, it is important to speak with your doctor about fertility ideally prior to treatment, so that the full array of options remain available.

Habib Shaikh MD, Fellow in Hematology Oncology


References

[1.] Schilsky RL; Lewis BJ; Sherins RJ; Young RC. Gonadal dysfunction in

patients receiving chemotherapy for cancer. Ann Intern Med 1980

Jul;93(1):109-14.

[2.] Falcone T; Attaran M; Bedaiwy MA; Goldberg JM. Ovarian function

preservation in the cancer patient. Fertil Steril 2004 Feb;81(2):243-57.

[3.] Hortobagyi GN; Buzdar AU; Marcus CE; Smith TL. Immediate and long-term

toxicity of adjuvant chemotherapy regimens containing doxorubicin in

trials at M.D. Anderson Hospital and Tumor Institute. NCI Monogr.

1986;(1):105-9.

[4.] Veeck LL; Bodine R; Clarke RN; Berrios R; Libraro J; Moschini RM;

Zaninovic N; Rosenwaks Z. High pregnancy rates can be achieved after

freezing and thawing human blastocysts. Fertil Steril 2004

Nov;82(5):1418-27.

[5.] Gosden RRG. Prospects for oocyte banking and in vitro maturation. J

Natl Cancer Inst Monogr 2005;(34):60-3.

[6.] Kim SS; Lee WS; Chung MK; Lee HC; Lee HH; Hill D. Long-term ovarian

function and fertility after heterotopic autotransplantation of cryobanked

human ovarian tissue: 8-year experience in cancer patients. Fertil

Steril. 2009 Jun;91(6):2349-54.

[7.] Lobo RA. Potential Options for preservation of fertility in women. N

Engl J Med 2005; 353:64–73.

[8.] Green DM; Whitton JA; Stovall M; Mertens AC; Donaldson SS; Ruymann FB;

Pendergrass TW; Robison LL . Pregnancy outcome of female survivors of

childhood cancer: a report from the Childhood Cancer Survivor Study. Am J

Obstet Gynecol 2002 Oct;187(4):1070-80.