breast cancerOne of the most prevalent forms of cancer affecting women, it is traditionally associated with menopausal women, typically in women 50 years of age and older. However, there have been recent changes lifestyle The increase in patterns and unhealthy habits has given rise to a worrying trend: Younger women, including those of childbearing age, are now at increased risk of developing breast cancer.

For women with breast cancer who have not yet completed their family, the possibility of future motherhood becomes an important consideration. It is important to consider fertility preservation options before starting cancer treatment to protect your chances of having children in the future.

We spoke to Dr Rucha Kaushik, consultant breast cancer surgeon at PD Hinduja Hospital and MRC, about how breast cancer can affect your fertility.

Effect of breast cancer treatment on fertility

The treatment journey for breast cancer generally starts with surgery, especially in early-stage cases. Depending on the specific characteristics of the cancer, this may be followed by chemotherapy, radiotherapy (radiation), and hormone therapy. Each of these treatment methods may have different effects on a woman’s fertility:

Surgical intervention for breast cancer, whether lumpectomy or mastectomy, does not directly affect a woman’s reproductive abilities. The ovaries and uterus remain unaffected, allowing future pregnancies.

Of the breast cancer treatments, chemotherapy poses the greatest risk to fertility. The powerful drugs used in chemotherapy can damage the ovaries, potentially leading to:

• temporary or permanent cessation of menstruation
• Decreased ovarian reserve (number of viable eggs)
• Premature ovarian failure (early menopause)

The effect of chemotherapy on fertility varies depending on the woman’s age:

• Women over 30: There is a relatively good chance that menstruation will function properly after chemotherapy, as well as the possibility of natural conception.
• Women over 40: Menstruation is less likely to return after chemotherapy. For these women, it is important to discuss fertility preservation options before starting treatment.

radiotherapy

While radiation therapy for breast cancer does not directly affect the reproductive organs, it is important to note that it is often administered after chemotherapy and before hormone therapy. The cumulative effect of these treatments may affect overall fertility.

hormone therapy

For women with hormone-sensitive breast cancer, hormone therapy is a standard part of the treatment regimen. This therapy usually lasts for 5 to 10 years, during which pregnancy is prohibited because of potential harm to the developing fetus. After completing hormone therapy, women can conceive naturally or through assisted reproductive technologies if they have preserved their eggs.

fertility preservation options

Specialized fertility preservation clinics provide invaluable services to women facing breast cancer treatment. These clinics provide:

1. Comprehensive counseling on reproductive risks associated with cancer treatment
2. Guidance on various fertility preservation methods
3. Help in conducting the process of freezing eggs or embryos

The most common fertility preservation options include:

• Egg freezing (oocyte cryopreservation): This involves stimulating the ovaries to produce multiple eggs, which are then retrieved and frozen for future use.

• Embryo freezing: Similar to egg freezing, but before freezing the eggs are fertilized with sperm, creating embryos.

• Ovarian tissue freezing: A portion of the ovarian tissue is surgically removed and frozen, potentially allowing reimplantation at a later date.

Key points for women

1. Age at diagnosis:

• Women diagnosed at age 30 usually have a better prognosis with improved fertility after treatment.
• Women over the age of 40 should strongly consider fertility preservation before starting chemotherapy due to the high risk of permanent ovarian failure.

2. Aggressiveness of cancer: Understanding the nature and aggressiveness of cancer is important in making informed decisions about both treatment and fertility preservation.

3. Timeline: Fertility preservation procedures typically take 2-3 weeks, which may delay starting cancer treatment. This timeline should be discussed with both the oncology and fertility teams.

4. Future family planning: Women should consider their desired family size and timing of childbearing when making decisions about fertility preservation.

5. Financial considerations: Fertility protection can be expensive, and insurance coverage varies. Some organizations provide financial assistance to cancer patients seeking fertility preservation.

6. Emotional support: Dealing with a cancer diagnosis can be emotionally challenging when making decisions about future fertility. Psychological support should be easily available.

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