When to get pregnant after treatment?

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Question from Nadia: How long does it take for a woman to become pregnant after she received breast cancer treatment?
Answers - Kutluk Oktay, M.D. If I interpret this question correctly, you're asking how long you should wait after breast cancer to attempt pregnancy. This is a much-debated issue. However, recently it has been suggested that—especially with earlier stage breast cancers—pregnancy does not necessarily increase the risk of recurrence. People have suggested between two to five years to wait after completion of chemotherapy.
Marisa Weiss, M.D. That's a long time to wait if you're already in your 30s and you want very much to start a family.
Kutluk Oktay, M.D. Yes, that's why even in a 30-year-old or even someone in her 20s, the issue of chemotherapy and egg loss is important. Even though a younger patient may not be plunged into menopause immediately, her reproductive life is shortened. After those two to five years, which are often spent using tamoxifen when she's not allowed to get pregnant, she may then experience menopause and infertility as well as the added effects of age.
Marisa Weiss, M.D. That's certainly true. For sure, as women grow older and we're in our 30s, our fertility naturally decreases with age, even separate from all the potential effects of breast cancer treatment.
Kutluk Oktay, M.D. One more issue here is that many women want not just one child, but a bigger family. Even if younger women can squeeze one child into that shortened reproductive life after breast cancer treatment, there's the issue of a second or third child. So even patients in their 20s may have a justifiable reason to resort to a fertility preservation strategy.
Marisa Weiss, M.D. That's an excellent point that many oncologists don't really focus on, and that is a woman's desire to have not just one child, but more, if at all possible.
Kutluk Oktay, M.D. The idea is to have a family, not just be fertile on the books. So the purpose is to help women have the size of family they desire.

There's another reason women shouldn't get pregnant right away after treatment: Even if they have a favorable prognosis, we would wait at least six months after completion of chemotherapy, because there will be some eggs that may be damaged (from chemotherapy) that will remain in the ovaries, and can cause miscarriage and birth defects. That's why we want women to wait at least six months so the ovaries can cleanse themselves from these damaged eggs.
Marisa Weiss, M.D. What if your prognosis is more serious: say you have lymph nodes involved, or the cancer is large in size, or the doctor says, "It looks aggressive?"
Kutluk Oktay, M.D. In very aggressive cases where oncologists don't feel comfortable about allowing pregnancy in the near term or at all, the only choice might be to use a gestational carrier (surrogate mother). For aggressive cancers or advanced stage tumors, the level of comfort with pregnancy is much lower and the information is much less available. If pregnancy is not safe, there are ways to deal with that, as well.
Marisa Weiss, M.D. You mean the pregnancy may be considered unsafe because your doctor wants to watch you for the first few years after treatment because of fear of recurrence—not that the pregnancy brings on the recurrence, but because they want to watch you carefully and make sure you're OK before you take on the physical challenge of pregnancy?
Kutluk Oktay, M.D. That is true, or they may want you to be on tamoxifen or an aromatase inhibitor for a while.
Marisa Weiss, M.D. You just hit on a very common difficult choice that women might have to face. That is, that if tamoxifen is likely to be a benefit, your doctor will want you to be on it for a significant length of time in order to get that significant benefit. And while you're on tamoxifen, your doctor will want you to avoid getting pregnant.
Kutluk Oktay, M.D. Depending on your age when you receive chemotherapy, by the time your doctor feels comfortable with it, you may not feel comfortable about getting pregnant. In that case, you may want to use a gestational carrier (surrogate) if you have frozen embryos from before chemotherapy.

A gestational carrier is a person who can be related to you or contracted by you to carry your embryos, either generated with your egg and your partner's sperm, or with the carrier's egg.

The Ask-the-Expert Online Conference called Pregnancy and Fertility Issues featured Kutluk Oktay, M.D., Leslie Schover, Ph.D., and moderator Marisa Weiss, M.D. answering your questions about pregnancy and fertility before, during, and after breast cancer treatment, as well as the options of adoption and gestational carriers (surrogate mothers).

Editor's Note: This conference took place in August 2004.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Copyright 2010. All rights reserved.

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