Find out how breast cancer might affect your fertility, and how you might preserve your fertility if you’re having treatment.
Some women can get pregnant naturally after their cancer treatment. But other women find they are unable to have children after treatment.
Your diagnosis might mean you have to think about your fertility earlier than you had planned. And having treatment that affects whether you can have children can be very difficult to cope with. Some women find this as difficult to come to terms with as their cancer diagnosis.
Talk to your doctor about your fertility before your cancer treatment. Your team are there to help you find a balance between treating your cancer and wanting to have children. National guidelines for doctors say that they should discuss how your cancer and its treatment might affect your fertility at diagnosis.
Doctors are interested in new ways of preserving fertility for women with breast cancer. Research is ongoing to find out how well they work and how safe they are.
IVF (freezing embryos)
At the moment, in vitro fertilisation (IVF) is the most effective way of preserving fertility. You take hormones to stimulate your ovaries to make eggs. A doctor removes the eggs and fertilises them with sperm. It's possible to use donor sperm if you don’t have a male partner at this stage.
This creates an embryo which can be frozen and stored. After treatment, the doctor puts one or more of the eggs into your womb to try to make you pregnant.
Doctors don’t know what effect increasing hormone levels for women with hormone positive breast cancer is. Researchers have been looking into different ways of doing IVF including:
- natural cycle IVF – using no hormones. This is at the investigation stage and so far it hasn’t been as successful as regular IVF
- collecting eggs from the ovaries using smaller doses of hormones
- testing different hormone therapies to stimulate the ovaries including tamoxifen and aromatase inhibitors either on their own or in combination with a lower dose of IVF hormones
IVF takes time and could result in a delay to your cancer treatment.
Talk to your doctor about whether having IVF could be a possibility. It's available for some people on the NHS but not in all parts of the country. The number of treatments you can have varies from area to area. You need to check with your doctor to find out what is available for you.
Doctors are able to take out and freeze women’s eggs. The process is very similar to IVF. You might prefer this method if you have no male partner and don’t want to use donor sperm.
Again, you need hormones to stimulate the ovaries to produce the eggs, which are collected and frozen. When you want to use the eggs they are thawed and injected with sperm to fertilise them. The problem is that freezing and thawing eggs seems to damage them and has not been very successful. So there haven’t been many babies born due to this treatment.
Talk to your doctor to see if this is available in your area and if it is safe to do before starting treatment.
Ovarian tissue freezing
You can have a small operation to remove some ovarian tissue, which is then frozen. The tissue is put back once your cancer treatment has finished.
This is a new treatment and very much in the early stages of development. There is very little evidence at the moment about how well it works but there have been reports of women having babies after this procedure.
Reducing the impact of chemotherapy on fertility
Some chemotherapy drugs permanently stop the ovaries from producing eggs. If this happens, you can no longer get pregnant and you may have menopausal symptoms.
Some chemotherapy drug combinations, such as FEC or AC, are less likely to affect your fertility than others, such as CMF.
Having FEC or AC doesn’t mean treatment definitely won’t affect your ovaries, but the risk is smaller. If you are over 40 there is a greater risk of fertility problems with any chemotherapy.
Researchers are also looking into using hormone treatment to protect the ovaries from chemotherapy. This means having injections of hormones called luteinising hormone blockers (LH blockers), for example goserelin (Zoladex), while you're having chemotherapy.
The aim is that the LH blockers stop your ovaries working during the time you have treatment. Once you finish treatment you stop the injections and your ovaries start working again. The evidence so far is mixed and we need more research to find out whether this does preserve fertility.