How Breast Cancer Affects Fertility
What there is to know about having a baby when you have breast cancer.
Age of Patient
Age plays a big role in patients' future fertility. "The age of the
woman at the start of systemic chemotherapy is the biggest predictor of
infertility," Barbierri tells WebMD. But why?
"If you're 30, your fertility is already declining. Add to that
chemotherapy, and you tack on a few more years. We know that chemotherapy
induces menopause, particularly with women over 40," Domcheck says.
Despite the fertility risks associated with breast cancer treatment
(chemotherapy in particular), methods to preserve fertility prior to treatment
offer hope to many patients.
To date, freezing embryos (fertilized eggs) created by in vitro
fertilization (IVF) is the most widely used and effective method of preserving
fertility. But there are potential downsides. IVF takes three to four weeks, a
delay in cancer treatment that, depending on the stage and type of cancer,
patients may or may not be able to afford. Sperm -- either from a partner or
donor -- must be made available immediately to fertilize the eggs. And IVF is
expensive -- anywhere from $10,000 to $14,000 per cycle.
Other methods of fertility preservation, albeit experimental, show promise.
Egg freezing, which applies the same concept as embryo freezing, has proven
less effective -- most likely because eggs are smaller, and less hardy, than
embryos. There's also ovarian suppression during treatment, which "protects
ovaries to some degree from chemical onslaught of chemotherapy," Barbierri
tells WebMD. Freezing entire strips of ovarian tissue is a third technique
under investigation; it involves surgically removing, storing, and later
replacing the tissue in another part of the body.
Tamoxifen, a drug traditionally used to prevent breast cancer reoccurrence,
was recently found to stimulate ovaries in breast cancer survivors during an
IVF cycle, enhancing both egg and embryo production. This extra boost can
combat infertility barriers such as age and the diminishing ovarian reserves,
which occurs naturally with aging, notes Oktay.
Although males rarely develop breast cancer, it does happen. For male breast
cancer patients who must undergo chemotherapy and want to preserve their
fertility, freezing sperm is an effective option. "Since there are millions
of sperm, even if you kill half in the freezing process, you still have a lot
left," Barbierri explains.
Researchers' focus on fine-tuning methods of fertility preservation fuel
optimism about its increasing viability. "A decade ago, there was
practically no emphasis on fertility preservation. Today, there are several
methods and thus a much greater potential," Oktay tells WebMD.