Your Risk of Infertility

Every woman views the risk of infertility in light of her background, her hopes, and her expectations. You may not know if you're fertile—separate from the whole breast cancer issue. You may be thinking about having your first child after age 35, when fertility is lower than it would have been in your 20s. You may have had fertility treatment for a prior pregnancy, and you're expecting that getting pregnant again will also be a challenge. Or maybe in the past it seems you've been able to get pregnant by just looking at your partner (more or less), and you're wondering if that will change after treatment.

Talk to your doctor about what you can expect. If your doctor tells you that your risk of becoming infertile after treatment is very low, you can let go of that worry and concentrate on cancer therapy issues.

If your risk of infertility after chemotherapy is significant, or an optimistic projection does not reassure you, get more information before starting any breast cancer therapy. Arrange to see a fertility specialist—also called a reproductive endocrinologist. That consultation will help you learn more about your risk and the management of infertility brought on by cancer treatment.

You'll need some "pull" to get an immediate appointment with this specialist. Ask your doctor to call the specialist's office and be persistent on your behalf. You're entitled to special consideration because of the pressure to start cancer treatment, but you have to ask for it.

It's also important to ask if the specialist has any expertise in taking care of cancer patients with infertility concerns, and in fertility preservation techniques.

If there is no such specialist in your area, you may have to rely on your gynecologist. For many infertility problems that may be fine. But it still makes sense to do a lot of reading or to go to the Internet for as much information as you can dig up.

An excellent resource for information is Fertile Hope, a nonprofit organization dedicated to helping cancer patients faced with fertility concerns.

You can—and should—hold off briefly on chemotherapy and radiation until you deal with these issues. Postponing your treatment for a week or so to discuss your questions and obtain necessary information is time well spent. In most cases, this short delay will not endanger your health.

Try to schedule an appointment with the specialist before your next period. This is important, because some fertility treatments need to be started right when your period starts. If you see the doctor after the first three days of your cycle, you may have to wait another month for the fertility treatments. This would delay the start of your cancer therapy even longer. Ask your doctor whether this delay is OK or risky. Then coordinate the fertility plan with each recommended cancer therapy.