Fertility and Breast Cancer

Written By Guest User

Written by Melody Hyde, an undergraduate student at UNCW and a Public Health Intern at Going Beyond the Pink.

What is Fertility? 

The ability to conceive after treatment for breast cancer is a significant concern for women facing breast cancer diagnosis during their childbearing years. During this challenging time, the primary focus is often on treating the cancer itself and thoughts of a family may be set aside. However, whether you’ve always been planning for motherhood or are uncertain about it, it's crucial to be aware that certain breast cancer treatments can impact your fertility. 

Why does Fertility become an issue? 

Fertility becomes an issue because treatment can affect the functioning of the ovaries, reducing the number and quality of eggs. Fertility problems also depend on the type of drugs used, the dose given, your age, and what your fertility was like before breast cancer treatment. 

Chemotherapy and Hormonal Therapy: 

Chemotherapy: can lead to a reduction in the number of eggs stored in the ovaries. 

Chemotherapy can lead to the cessation of menstrual periods, which can either be a temporary or permanent effect. Typically, the chances of menstruation returning are higher if the individual is younger at the time of treatment, especially if they are under 35. However, for women over the age of 35, the likelihood of losing fertility after chemotherapy is increased.

Hormonal Therapy: medicines used in women whose breast cancer is estrogen receptor positive (ER+).

In the majority of pre-menopausal women using tamoxifen, their ovaries typically remain active. Upon commencing tamoxifen treatment, it might induce ovulation (the release of an egg from the ovary) and potentially enhance fertility. Nevertheless, becoming pregnant while on tamoxifen is not advisable. 

The probability of experiencing fertility issues later on hinges on several factors, including the specific drugs used, the dosage administered, your age, and your pre-existing fertility condition before undergoing breast cancer treatment. Typically, there is an opportunity to take some time to contemplate fertility preservation options before commencing treatment. If your desire is to have children in the future, make sure to have an open discussion with your breast cancer team. 

Estrogen 

About two-thirds of breast cancer cases are characterized as estrogen-receptor positive, indicating that the cancer cells thrive in the presence of estrogen. For women diagnosed with estrogen-receptor positive breast cancer, tamoxifen is often prescribed as a preventive measure against cancer recurrence. This medicine functions by obstructing estrogen’s actions in the body and causes menopause-like symptoms affecting fertility. 

Another class of drugs often prescribed are aromatase inhibitors which are used to reduce estrogen levels in the body. However this reduction in estrogen can also trigger menopause symptoms. Premenopausal women are not typically prescribed aromatase inhibitors unless they simultaneously receive medication to halt estrogen production in the ovaries, a process referred to as estrogen suppression. 

Coping with Fertility Loss

The impact of losing fertility can extend to every aspect of someone’s life- from the way you feel about yourself, to your interpersonal connections with friends and loved ones.  While not everyone's life plan necessarily includes having children, for certain individuals, the most challenging aspect to come to terms with is the loss of the opportunity to choose - "I lost my ability to have children even before I knew I wanted them."

Here are some things to keep in mind for coping: 

Let yourself feel, educate yourself about options, communicate your priorities with your loved ones and your care team, avoid the “blame game”, and seek support. 

Communicating Concerns

The conversation of fertility can certainly be discussed with your medical team. It is okay to bring it up yourself. While discussing fertility can be sensitive and challenging, having an open conversation with your health care team before and during treatment can significantly enhance your prospects of preserving fertility options for the future. To help guide the discussion, consider asking your doctor the following questions:

  • Will my treatment plan affect my fertility? If so, will this treatment affect my fertility short-term or long-term?

  • If my treatment affects my fertility, what possible solutions are covered by my insurance? And what steps do I need to take before starting treatment? 

  • How much time can I safely take to explore my options before I have to make a decision?

  • Should I talk to a fertility specialist? If so, can you recommend one?

  • When can I start trying to conceive after my treatment is finished? It is important to maintain open and honest communication with your health care team to receive the best care possible.

  • What are my options if it is too late to explore fertility preservation?

Facing fertility concerns while also trying to manage the overwhelm of a cancer diagnosis can be difficult. We encourage you to communicate with your physician about your treatment and lifestyle priorities. Physicians want to understand your goals and what is important to your quality of life so they can provide recommendations with your unique needs in mind. 

Loss of fertility can lead to significant grief. We also recommend seeking counseling from a qualified professional who can help you navigate through these difficult choices and the ways they impact your life. Consider searching for oncology trained therapists and counselors in your area. 

Want to dive deeper into breast cancer and fertility? We suggest the following resources: 




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