Protecting Fertility During Breast Cancer Treatment
For many people, breast cancer treatment involves chemotherapy, radiation therapy, or a combination of the two. These treatments can affect your reproductive system and, as a result, your fertility.
Chemotherapy is the use of drugs to kill cancer cells. However, these drugs also kill some healthy cells, including those involved in the production of eggs. The type of chemotherapy drug or drugs used, the length of treatment, and the person's age at the time of treatment are all factors that can affect fertility. For some, the effect of chemotherapy on fertility is temporary. For others, it may be permanent. There is currently no known way to protect the ovaries completely during chemotherapy.
Triple-negative breast cancer (TNBC) is defined as the absence of staining for estrogen receptor, progesterone receptor, and HER2/neu. TNBC is insensitive to some of the most effective therapies available for breast cancer treatment including HER2-directed therapy such as trastuzumab and endocrine therapies such as tamoxifen or the aromatase inhibitors. Combination cytotoxic chemotherapy administered in a dose-dense or metronomic schedule remains the standard therapy for early-stage TNBC. A prospective...
Radiation therapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. Radiation kills cancer cells by interfering with their growth and division. The potential for fertility problems due to radiation therapy are not as great as for chemotherapy because the area affected by cancer is away from the reproductive organs. However, because external radiation beams often pass through healthy tissues, the organs near the cancer site may be affected by the radiation, which can lead to either temporary or permanent infertility.
Factors that affect sexual desire can also be a problem for someone who may want to become pregnant. For example, a decreased sex drive is a possible complication of breast cancer treatment. This may result from hormonal changes caused by the treatment or from fatigue and nausea that often accompanies cancer therapy. Self-image and emotional factors can also impact sexual desire.
Be sure to discuss your concerns about fertility with your doctor before you begin breast cancer treatment.
Can Fertility Be Preserved After Breast Cancer Treatment?
There are ways for breast cancer survivors to increase their chances of having children following treatment. These include:
Cryopreservation, the process of freezing and storing embryos (fertilized eggs) for later use. The embryos can be implanted in the woman after she recovers from breast cancer treatment or in a surrogate (a woman who carries the baby when the natural mother is unable). Unfertilized eggs are more delicate and can be easily damaged during the freezing process. For this reason, cryopreservation of unfertilized eggs is less effective. Improvements in the techniques of assisted reproduction -- such as in vitro fertilization (a procedure in which thousands of sperm are placed in a laboratory dish with an egg) and intracytoplasmic sperm injection (a procedure in which a sperm is injected directly into an egg) -- have increased the production of usable embryos for cryopreservation.
Use of less toxic chemotherapy drugs. While some chemotherapy drugs may cause less damage to the reproductive organs, these drugs may also be less effective at treating breast cancer. Your oncologist can determine if a less toxic chemotherapy drug is appropriate for your cancer treatment.
Researchers also are looking at new methods of treatment that spare the reproductive system, such as hormonal suppression of the reproductive organs. This approach involves using hormones to place the reproductive organs in a dormant (inactive) state, shutting down your body's production of eggs. This process seems to protect the cells that develop into eggs (germ cells) from damage by chemotherapy and radiation