Fertility During and After Breast Cancer

Conquering breast cancer is an intense and emotional journey. The future can look different in many ways, including making decisions about having a child.

Rachel David, MD, specializes in medical oncology at Rochester Regional Health and provides perspective into the intersection of fertility and post-breast cancer life.

Can I get pregnant after breast cancer?

Pregnancy is possible for women who have been treated for breast cancer. While there are certain types of treatment that can damage a woman’s ovaries, successful pregnancies are not out of question.

The likelihood of a woman becoming pregnant can depend on several factors, including:

• Overall health
• Stage of the tumor
• If cancer has spread
• If chemotherapy is used, how much was administered
• Patient’s timeline for family planning

It is important to have conversations with your oncologist and OBGYN provider about your reproductive system before and after your treatments. After initial conversations, a medical oncologist will send any potential treatment options, including chemotherapy and other medications, to the patient’s primary care provider so the primary care provider can discuss fertility and pregnancy together with their patient.

“We are able to offer the mother a very high standard of care and not harm the baby,” Dr. David said. “From the moment of diagnosis and each day afterward, we work very closely with other doctors and specialists to minimize any risks or issues to everyone involved.”

Do cancer treatments affect my ability to get pregnant?

Some treatments have no effect on a woman’s ability to become pregnant and have a baby. Some treatments do affect a woman’s fertility.

Surgery, radiation, and immunotherapy are all common courses of treatment for breast cancer. None of these lower a woman’s chances of becoming pregnant in the future.

Chemotherapy is considered to be an increased risk to a woman’s ovaries and her own eggs. Some of the agents that affect the ovaries include:

• Platinum agents
• Alkylating agents (i.e., cytoxan)
• Taxanes
• Anthracyclines

If a woman does become pregnant and successfully gives birth to a baby, there can be some complications related to breastfeeding. Sitting down with a lactation consultation and figuring out the best way to feed your baby is something that new mothers are strongly encouraged to do.

How long after my treatment should I wait to get pregnant?

Breast cancer survivors should have a conversation with their doctor and ensure they are in full remission.

Experts suggest most women wait for 6-12 months after the conclusion of a final treatment to start trying to get pregnant.

The reasoning behind this waiting period is the need for the body to get rid of some of the chemotherapeutic agents. It can take a minimum of 3-6 months to fully metabolize and excrete some of that material.

“There can be some lingering effects of the chemotherapy agents,” Dr. David said. “Once a woman has gone through that waiting period, she is likely to be in her best health and in a better position to have a healthy pregnancy as well.”

Since a woman’s body releases higher levels of the estrogen hormone during pregnancy and cancer experts believe some tumors can grow larger with the help of more estrogen, doctors recommend patients with estrogen-sensitive tumors wait 2 years before trying to get pregnant. During those 2 years, they should be on an estrogen blocker. Once the patient decides she does not want to have any more children, she can resume the estrogen blocker to finish the standard course of treatment.

What if I’m pregnant and being treated currently?

Being diagnosed with breast cancer during a pregnancy can be quite scary. Having a team of highly trained specialists like the ones at Rochester Regional Health can help to lessen some of those fears.

Breast cancer is the most common form of cancer diagnosed in pregnant women, so carefully treating the disease is a very well-known and relevant topic to high-risk pregnancy doctors.

Women in this situation are paired with both an oncologist and a pregnancy doctor. They will assess a number of factors, including:

• Overall health
• Progression of the pregnancy
• Stages of the cancer
• Location of the cancer
• Personal health preferences of the mother

All of this information will be used to create a specific treatment plan.

“The health of the mother is our primary concern,” Dr. David said. “Our course of treatment is focused on how to ensure the mother will have the best outcome possible. The focus shifts toward the pregnancy after we know that the mother is going to be in a good position.”

“It is possible to have a good cancer outcome and a good baby outcome, too,” Dr. David added. “It depends on how far along someone in their pregnancy and what therapies we think they need in their pregnancy.”

If the cancer is more advanced, chemotherapy can be used to eradicate cancer from the mother’s body, while still paying close attention to the baby’s development and overall health. Since so much of the baby’s development happens in the first trimester of pregnancy, chemotherapy is not advised during this time.

Fertility preservation

If having children is not something a woman sees in her immediate future, there are ways she can preserve fertility that should be discussed with a doctor in the early stages of her breast cancer diagnosis.

Two of the most common options are freezing eggs or freezing embryos – both of which are services offered through Rochester Regional Health. Egg freezing involves harvesting a woman’s eggs and storing them in a cryogenic freezer until she is ready to thaw and fertilize them. Embryo freezing is a similar concept, but is done after an egg has been fertilized.

If the decision is made to freeze eggs or embryos, there is typically a 6-8 week window of time for them to be retrieved. After that timeframe, therapies needs to get underway.

Other fertility preservation options are in their early stages, including cryogenic preservation of ovarian tissue. In this procedure, ovarian tissue containing eggs is carefully removed during surgery and frozen. While not offered through Rochester Regional Health, this is a rapidly expanding procedure in the field of fertility preservation.

Even if a woman does not want to freeze her eggs or any embryos, there are methods to put her ovaries in a temporary menopausal state. This is often done through the use of Lupron Depot and can keep a woman’s ovaries from being injured by chemotherapy for about 3 months. Beyond fertility, keeping a woman’s ovaries healthy are integral for her heart and brain in the long term.

Approximately 30-40 percent of women are offered a referral to fertility preservation, according to Rochester Regional physicians. The sooner they are offered the choice, the better.