A 29-year-old lady who has been married just more than a year has been diagnosed with breast cancer. She wants to know what are her chances of getting pregnant in the future following treatment for breast cancer.
While surgery alone does not have an impact on future fertility, the use of additional (adjuvant) chemotherapy does affect fertility to a significant extent as it can bring forward the age of menopause. Studies have shown that even women who resume their periods following completion of chemotherapy may be less fertile. The impact of chehttps://www.kimshospitals.com/motherapy on the ovaries is dependent on the age at which the patient receives chemotherapy and the chemotherapy drugs used. Some chemotherapy drugs can cause more damage than others. Hence it is important that women after completion of chemotherapy should be referred to a fertility specialist at the earliest for advice and management.
What can be done to minimise the effect of chemotherapy on fertility? Are there any options available? Yes, there are treatment options such as GnRH (hormone) injections which can be used while the patients receive chemotherapy to minimise the damage on the ovary.
Freezing of gametes (egg) or embryo (embryo cryopreservation) or cryopreserving the ovarian tissue is the several different options, though none are perfect.
For those who are married to a partner, embryo cryopreservation is the best treatment choice. The treatment involves going through the IVF (In Vitro Fertilisation) (test tube baby) process, forming embryos and freezing them for future use. This achieves a pregnancy rate of around 20% per transfer of two to three embryos on average. However, it requires time for a woman to undergo ovarian stimulation-at at least 2 weeks but could be scheduled after surgery while recovering from the surgery prior to starting chemotherapy. Anti-estrogens are used along with the ovarian stimulation protocol to reduce the potential risk of elevated estradiol levels seen with IVF treatment.
Oocyte (egg) cryopreservation can be offered to unmarried women though the chances of success when the frozen eggs are thawed to make embryos are less compared to embryo cryopreservation.
Ovarian tissue freezing is also an option though very much still at a research stage –very few pregnancies have been reported worldwide using this technique.
Hormone therapy per se does not affect fertility but the duration of treatment of a few years when pregnancy is contraindicated could compromise fertility.
Large observational studies evaluating the safety of pregnancy after breast cancer have shown reassuring results showing that women who become pregnant are no more likely to suffer from a recurrence or die of the disease than women who do not.
It is ideal to wait at least two to three years to get through the early risk of recurrence and to complete endocrine therapy.
Many breast cancer therapies affect a woman’s chances of having a child in the future.
Women newly diagnosed with breast cancer are overwhelmed to deal with all issues related to therapy and fertility issues are not always addressed adequately. It is important to try to address fertility issues with patients. Some choose to go through the treatment of cancer first whereas others prefer to go through fertility preservation procedures first. The hope that fertility preservation offers can also serve as a strong impetus for a lady to deal with the diagnosis and treatment better. Refer to a fertility specialist early for assistance in implementing fertility preservation procedures.
It is also important for the medical fraternity to weigh up the need for adjuvant treatment for early breast cancer against impairment of fertility if future fertility is considered very important by the patient.
Fertility issues in breast cancer survivors pose complex and difficult challenges. Limited data are available and we should help to manage patient’s expectations and help them deal with the realities and sometimes the changes in their lives because of breast cancer.
DR.S.VYJAYANTHI, MD, DGO, DNB, MRCOG (London), MSc (Embryology) (UK)
Head of Department and Consultant in Infertility, Reproductive Medicine and Surgery
Krishna Institute of Medical Science