Fertility and Pregnancy After Breast Cancer
It’s possible to become pregnant after receiving breast cancer treatment. But doctors don’t always discuss fertility when explaining a breast cancer diagnosis and its potential treatments. If you would like to have children, it may be up to you to start the conversation so your doctor can take fertility options into account when developing a treatment plan.
Fertility and pregnancy after breast cancer
Most people who have been diagnosed with breast cancer receive a combination of treatments for the disease, regardless of the type of breast cancer or its stage and grade. Breast cancer treatments can affect fertility in different ways:
Some treatments can cause temporary infertility or make it more difficult for you to get pregnant.
Some treatments cause irreversible menopause, which means the infertility is permanent and you’re no longer able to get pregnant.
Some treatments, like radiation therapy, don’t affect fertility at all.
There are three hormonal therapy medicines approved for treating pre-menopausal women:
These hormonal therapy medicines can cause irregular periods or stop them entirely and stop the ovaries from producing eggs. After completing hormonal therapy, many pre-menopausal women start having periods again. But getting pregnant after hormonal therapy can be difficult for some.
Learn more about hormonal therapy.
Doctors can use medicines — called gonadotropin-releasing hormone (GnRH) agonists — to suppress, or stop, the ovaries from producing estrogen during chemotherapy. This is also called medical shutdown or ovarian suppression. The procedure is offered to pre-menopausal women who:
have been diagnosed with hormone receptor-positive breast cancer
have a very high risk of hormone receptor-positive breast cancer coming back (recurrence)
don’t want their ovaries surgically removed because they want to have children after completing their main breast cancer treatment
The GnRH agonists doctors use to stop ovarian function include:
Zoladex (chemical name: goserelin)
Lupron (chemical name: leuprolide)
Trelstar (chemical name: triptorelin)
These medicines block GnRH, a special hormone made in the brain that tells the ovaries to prepare for ovulation. Ovulation is the release of a mature egg from the ovary. The egg travels down the fallopian tube where fertilization by a sperm cell is possible. When GnRH is blocked, no ovulation occurs (temporary infertility). Fertility returns after you stop taking the medicine and the ovaries start making estrogen again.
You can get pregnant after chemotherapy treatment for breast cancer. But it depends on your age and the types and doses of chemotherapy medicines you've received.
Early menopause brought on by chemotherapy may be temporary, especially for younger women. Sometimes it can take between a few months and even a year or more for periods to return. Typically, younger women are able to get pregnant after completing chemotherapy because their ovaries have a larger egg reserve than women who are 40 and older. Still, if you want to have children, you may want to have your ovarian reserve checked by a specialist before starting chemotherapy regardless of how old you are.
Breast cancer is almost always treated with a combination of two or more chemotherapy medicines at various doses. Both of these factors may affect fertility in different ways. But those who get high doses of chemotherapy are more likely to be infertile after treatment than those who get lower doses.
There’s a medium to high risk that the following chemotherapy medicines may cause infertility:
Cytoxan (chemical name: cyclophosphamide)
Platinol (chemical name: cisplatin)
Adriamycin (chemical name: doxorubicin)
The following chemotherapy medicines are less likely to cause infertility:
methotrexate (brand names: Mexate, Folex, Rheumatrex)
fluorouracil (also called 5-fluorouracil) (brand name: Adrucil)
vincristine (brand names: Oncovin, Vincasar PES, Vincrex)
It’s not yet clear whether the taxanes — chemotherapy drugs that prevent cancer cells from replicating — affect fertility. If your treatment plan includes Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel), or Abraxane (chemical name: albumin-bound or nab-paclitaxel) and you would like to get pregnant one day, it’s important to talk to your doctor and fertility specialist about the potential risk of infertility.
Targeted therapies attack certain types of cancer cells. Some types of targeted therapies prevent enzymes, proteins, or other molecules from allowing cancer cells to grow or spread. Other types of targeted therapies help the immune system kill cancer cells or deliver toxic substances directly to cancer cells to kill them. Targeted therapies are generally less likely than chemotherapy to harm healthy cells and may have fewer side effects than other types of breast cancer treatment.
If you’re receiving targeted therapies to treat breast cancer and want to get pregnant one day, it’s important to let your doctor or fertility specialist know. Together, you can determine how soon after treatment it’s safe for you to get pregnant.
Radiation treatment for breast cancer has no effect on fertility. The small amount of radiation that might scatter from the breast is unlikely to affect immature eggs in the ovaries. Still, doctors recommend you start fertility treatment before having radiation therapy after chemotherapy.
Fertility treatment may involve removing some of your ovarian tissue and freezing it, or collecting eggs, fertilizing them, and saving them for after you complete your main breast cancer treatment. There is no evidence to suggest that radiation therapy is any less effective if it’s postponed until after eggs are collected.
Birth control methods that use hormones — such as birth control pills, shots, and implants — may increase breast cancer risk. Doctors often recommend that pre-menopausal women with a history of breast cancer use non-hormonal methods instead. These non-hormonal birth control methods include condoms, diaphragms, or non-hormonal IUDs, such as ParaGard or Phexxi. Doctors advise using non-hormonal birth control to avoid getting pregnant during chemotherapy treatment.
Pregnancy after breast cancer
You might be wondering whether pregnancy is safe after breast cancer treatment. Doctors generally recommend that pre-menopausal women diagnosed with early-stage breast cancer wait two years after completing treatment to get pregnant. This two-year wait is to see if the breast cancer comes back, which may affect your decision to get pregnant.
Being diagnosed with breast cancer while you’re pregnant can feel overwhelming. You might be wondering whether anything in your treatment plan could harm your baby, or worried that your treatments might not be as effective if you’re pregnant.
Receiving excellent breast cancer treatment during pregnancy is very important. The National Comprehensive Cancer Network (NCCN) — a group of 33 leading cancer institutions in the United States — developed guidelines for treating breast cancer during each stage of pregnancy. Hundreds of institutions around the world use these guidelines.
Learn more about treatment for breast cancer during pregnancy.
It’s considered safe to breastfeed a baby as long as you’re not receiving chemotherapy, hormonal therapy, or targeted therapy.
If you’ve had a single mastectomy, you can only breastfeed from the unaffected breast since a mastectomy removes the entire breast, including the milk ducts. If you’ve had a double mastectomy, it won’t be possible to breastfeed. Breastfeeding after a lumpectomy and radiation is possible, but both treatments may affect how much milk the affected breast produces.
There are a number of options to consider if you want to preserve your fertility during breast cancer treatment. Your doctor and fertility specialist can help you choose an option that makes sense for you.
Learn more about options if you can’t become pregnant after breast cancer treatment.
It’s natural for people with a gene mutation linked to hereditary cancer to feel concerned about passing the gene mutation on to their children. If you have one of these genetic mutations, each of your children has a 50% chance of inheriting it.
Learn more about preimplantation genetic testing for BRCA mutation carriers.
Questions to ask your doctor
Ask your doctor to outline the effects different breast cancer treatments have on fertility. It’s also a good idea to ask your doctor to refer you to a fertility specialist for counseling before treatment begins.
Some questions you may want to ask your doctor or fertility specialist include:
Do you feel confident that pregnancy is relatively safe for me?
Does freezing embryos or eggs make sense for me?
Can I freeze and store eggs now in case I 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 is less complicated?
Should some of my ovarian tissue be frozen instead of, or in addition to, my eggs or embryos?
Should I consider taking drugs to suppress ovarian function during chemotherapy?
What are the medical, financial, and scheduling demands and costs involved with each approach?
Can I postpone treatment? Would it be safe for me to postpone treatment for three to four weeks to allow time for ovulation stimulation and in vitro fertilization?
Are fertility drugs safe for me? Are the hormones used to stimulate ovulation safe for me or are the estrogen levels risky?
— Last updated on April 23, 2024 at 2:07 PM
