Breast cancer is not common in young women. Less than 5% of all breast cancers diagnosed in the U.S. occur in women under 40. However breast cancer
in younger women is usually more aggressive and is more likely for them to require chemotherapy. A breast cancer diagnosis can be very shocking for young women since usually at that time in life creating a family is a top priority, so it is really important to them to have fertility options.
The main concern for young women being treated for breast cancer is loss of fertility. Even though breast cancer itself does not impact fertility since it does not damage the ovaries and general reproductive health what impairs or threatens to impair fertility is the treatment of it. More specifically, the two major ways of treating breast cancer that can cause infertility are the chemotherapy and the endocrine therapy.
Standard cytotoxic chemotherapy for breast cancer can damage the ovaries and most of the regimens used for breast cancer seem to cause ovarian toxicity to some level. The level of fertility damage depends on the amount of therapy given and the specific regimen, as well as the age of the woman at diagnosis.
The other major factor is the time it takes to receive appropriate endocrine therapy. Hormonal therapies (tamoxifen, ovarian suppression) are usually given for a period of 5 to 10 years. During that time it’s not that the woman’s reproductive system is damaged by the drugs but it is modified or suppressed in the short term, not permanently. The problem with that is while women are on these drugs their ovaries still aging in time as they naturally do in women growing older.
Breast Cancer and Fertility Options
Two are the main ways to preserve the fertility and increase the chance of having children later:
- Cryopreservation, the process of freezing and storing embryos or oocytes for later use. After ovarian stimulation fertility specialists will get oocytes and get them fertilized in a test tube—classic IVF. The embryos can be implanted in the womb after full treatment recovery. The other option is to freeze the oocytes for later use, a method that has now proved out quite successful.
- Ovary suppression, a method that spares the reproductive system. This approach uses drugs called gonadotropin-releasing hormone (GnRH) analogs that can suppress the ovarian function through treatment and temporarily shut down the body’s production of eggs. This process seems to protect the cells that develop into eggs from damage during breast cancer treatment.
Those are the main options and there are more experimental things on the way, including taking a piece of the ovary and freezing that. There is a lot of research going into that so it is likely that more fertility options will come up in the future for women treated for breast cancer.
Would you discuss your options with a fertility specialist before making treatment decisions?
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