Fertility Issues

Most doctors define infertility as not being able to become pregnant after 1 year of trying or not being able to maintain a pregnancy.

At some point in their lives, most people think about having children. While not everyone decides to have kids, most people want the option. Some treatments for breast cancer can cause temporary infertility or make it harder for you to get pregnant after treatment ends. Other treatments cause permanent and irreversible menopause, which means you are permanently infertile.

There are 3 hormonal therapies approved for treating premenopausal women: tamoxifen, Evista (chemical name: raloxifene), and Fareston (chemical name: toremifene). These hormonal therapies can cause your periods to become irregular or stop and make your ovaries stop producing eggs. Many women are still fertile and start their periods again after hormonal therapy treatment is done. But it's important to know that some women have problems getting pregnant after hormonal therapy.

Ovarian shutdown (which is done with medication and surgical removal of the ovaries) causes your body to stop releasing eggs each month so you are no longer fertile. This infertility is permanent.

Chemotherapy may damage some of the eggs in your ovaries and may cause your periods to become irregular or stop. If you are premenopausal before starting chemotherapy, your periods may come back after treatment ends. Even if your periods don't come back, you may still be fertile. If you're close to menopause when you start chemotherapy, your periods may never come back and you are permanently infertile.

Managing fertility issues

Most doctors consider treating breast cancer more important than fertility issues. But you may not have to choose one or the other. Many women successfully go through treatment and then have a healthy baby.

Talk to your doctor about your fertility options:

• What's your prognosis? How serious is your condition? Is your prognosis good? Are you encouraged to become a parent in the future? Or does your prognosis make you not want to take added risks?
• How safe is it for you to become pregnant? Talk to your doctor about the safety of pregnancy as it relates to your particular kind of cancer. There isn't definitive evidence that pregnancy affects the prognosis of women diagnosed with breast cancer. But every situation is unique and needs to be evaluated.

If your prognosis is good and pregnancy would be relatively safe, talk to your doctor and a fertility expert about your options for preserving fertility. Do this before you start treatment. You'll probably want to consider these questions:

• Can you bank fertilized eggs now, in case you can't produce eggs later?
• Is ovarian stimulation (with in vitro fertilization) the only realistic option for getting enough eggs?
• Is there another type of fertility treatment that might be less risky for you?
• Should some of your ovarian tissue be frozen instead of, or in addition to, your eggs?
• Should you consider taking drugs to suppress your ovaries during chemotherapy?
• What are the demands and costs involved -- medically, financially, and time-wise -- with each approach?
• Can you postpone treatment? Would it be safe for you to postpone treatment for 6 weeks to allow time for ovulation stimulation and in vitro fertilization?
• Are fertility drugs safe for you? Are the hormones that will be used to stimulate ovulation safe for you or are the estrogen levels risky?
• Whose sperm will you use? If you're in a committed relationship with a man, you need to be sure both you and your partner are equally committed to having children. If you're single or in a committed relationship with a woman, you, or you and your partner, have to consider whether you're willing to pursue sperm donation.
• Can you afford fertility procedures? Find out if your health insurance covers fertility procedures and think about what you'll do if the procedures aren't completely covered.

If your ovaries permanently stop producing eggs after treatment, you can still be a parent if you are open to the idea of having a child without using your eggs. There are several options:

• Egg donation: Donated eggs come from women who volunteer to go through a cycle of hormone stimulation and have their eggs collected. After the eggs are retrieved from the donor and fertilized with your partner's (or donated) sperm, the embryo is transferred to your uterus.
• Embryo donation: A fertilized egg from another couple is transferred to your uterus.
• Surrogacy: A woman becomes pregnant through artificial insemination with your partner's sperm and carries the baby through birth.
• Adoption: Adoption is available to just about anyone who would like to become a parent. While some agencies prefer a two-parent household, many others are happy to place a child in a loving-single parent home. It's helpful to talk to an experienced adoption counselor who can help guide you through the process.