Section 8: Fertility, Pregnancy, and Motherhood After Breast Cancer

HIGHLIGHTS

  • This section explains how breast cancer treatment may affect your fertility, options to preserve your fertility, and what is known about the health of children born to breast cancer survivors.

  • The most common and successful ways to preserve fertility before breast cancer treatment involve going through a process to harvest eggs and either freeze them without being fertilized or freeze fertilized eggs with sperm from the woman’s partner or a sperm donor.

  • If women are pregnant at breast cancer diagnosis, most can be treated safely without terminating the pregnancy (chemotherapy can be given after the first three months of pregnancy, since the baby’s organs are, at this point, fully formed).

  • During and after breast cancer treatment women should use barrier methods of birth control (e.g., condom) to prevent unwanted pregnancies and protect themselves from sexually transmitted infections.

  • After breast cancer treatment, many women are able to get pregnant and have a healthy baby. However, these chances decrease for women who undergo chemotherapy. This process often prompts early menopause that ends her fertility.

  • If you hope to have a baby, it is a good idea to see a specialist and undergo tests to see if your cancer treatment has lowered your supply of eggs.

  • Current research shows that women who become pregnant after successful breast cancer treatment do not have a higher risk of cancer coming back or of dying from cancer.

  • Children born to women after completing breast cancer treatment do not have higher rates of birth defects. The family’s history of cancer may lead daughters to have a higher than usual lifetime risk of cancer themselves.

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SUMMARY

HOW CANCER TREATMENT INTERFERES WITH FERTILITY

Surgery or radiation to the breast do not damage fertility. It is chemotherapy that is usually the problem—all chemotherapy drugs do some damage to the ovaries, killing off some of the unripe eggs. Since a woman is born with all the eggs she will have in her life, this reduces her fertility. The effect on your fertility depends on your age. The younger you are when you get treatment, the more eggs you have left in your ovaries, so that you are more likely to continue having periods or recover periods after a few months.

Hormone therapies do not kill off your eggs, but for women already in their early 30s or older, spending 5 years on Tamoxifen may interfere with having children because by the time pregnancy becomes possible, the normal loss of fertility with aging may be a problem. Women should not become pregnant while on Tamoxifen because it can cause birth defects in the baby.

PRESERVING FERTILITY BEFORE BREAST CANCER TREATMENT

Although many women are able to get pregnant after breast cancer treatment, it is hard to predict your future fertility. If you would like to have children after breast cancer treatment, you may want to consider options to preserve your fertility. If you have recently been diagnosed with breast cancer, talk to your oncologist about fertility preservation as soon as possible to avoid delaying your cancer treatment. For most women, breast cancer treatment can be postponed for a few weeks without becoming less effective. A few women have very fast-growing cancer, however, and cannot take extra time for fertility preservation.

The following are the most common fertility options and their descriptions:

  • Freezing embryos. Storing frozen embryos is the most successful way to preserve fertility. A woman gives herself hormone shots for 2 to 3 weeks to make her ovaries ripen more than one egg. All ripe eggs are gathered in an outpatient surgery and then fertilized in a lab. Those embryos that start to grow are frozen for future use.

  • Freezing unfertilized eggs. A woman’s ova (eggs) that have been frozen for storage, then thawed and fertilized in the lab.

WHAT IF YOU ARE PREGNANT WHEN YOUR BREAST CANCER IS FOUND?

If you were pregnant when your breast cancer was diagnosed, your baby will likely be born healthy. In the past, pregnant women were often told to have an abortion if a breast cancer was found. Now we know that doctors can treat breast cancer successfully during pregnancy without harming the baby.

Breast surgery usually does not cause a miscarriage or damage the health of an unborn baby. If surgery happens during the first 6 months of pregnancy, women are usually advised to choose mastectomy (removing the whole breast) rather than lumpectomy. Radiation is important to the success of breast cancer treatment after lumpectomy, but would need to wait until after the birth of the baby. If a lumpectomy is done during the last month or two of pregnancy, radiation therapy can usually be safely delayed until after the baby is delivered.

Women with breast cancer can have chemotherapy after the first 3 months of a pregnancy. By this time, the basic organs in the fetus have formed, so that the chemo is less likely to cause birth defects. Chemotherapy should stop several weeks before delivery of the baby to decrease the mother’s chance of getting an infection related to childbirth. A woman should not breastfeed a baby during chemotherapy, however, because the drugs may get into her milk.

PREVENTING UNINTENDED PREGNANCIES AND SEXUALLY TRANSMITTED INFECTIONS

During and after treatment for breast cancer, it is important to use a reliable type of birth control if you are sexually active and do not want to become pregnant. Even if you stop having menstrual cycles during chemotherapy or hormonal therapy, you may still be able to get pregnant. Most oncologists do not recommend using birth control pills, hormone implants, or intrauterine devices (IUDs) containing hormones after treatment for breast cancer. Barrier methods, like a diaphragm plus spermicidal jelly, a vaginal sponge, or male or female condoms are good options. Condoms also help protect you from sexually transmitted infections.

HOW DO I KNOW IF I AM FERTILE AFTER BREAST CANCER?

If you have finished your breast cancer treatment and are thinking about having a child, you may wonder whether you could get pregnant if you tried. If you are still having periods, chances are that you could get pregnant. However, having periods does not mean you are fertile—and no periods does not guarantee you could not get pregnant, especially if you are under 35 years old. Blood tests and ultrasounds are more accurate ways of finding out your fertility. However, no test can ever say for sure whether or not you are fertile.

HOW HEALTHY ARE CHILDREN OF MOTHERS WITH BREAST CANCER?

If you already had children before your breast cancer diagnosis, your cancer is unlikely to affect their health in any way. If you get pregnant after your breast cancer treatment is finished, your baby should be normal and healthy. Most experts counsel women to wait at least 6 months after completing chemotherapy or hormonal therapy to begin trying to conceive, so that eggs exposed to cancer treatment during their months of ripening would already be used up. As far as we know, children born to a mother after her breast cancer treatment have no higher risk of birth defects (like nervous system problems, cleft palate, heart problems, etc.) than other children.


Click here for more in-depth information on what to do When Breast Cancer Interferes With Having a Baby and Paths to Parenthood.


Section 8: Fertility, Pregnancy, and Motherhood After Breast Cancer

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African American YBCS Survivor Quote

“My oncologists immediately recommended that I see reproductive endocrinologists prior to starting chemo if I had any hopes of possibly having children someday. I’m under 40. It’s a lot to think about in addition to the cancer diagnosis, but since my cancer is triple negative (and not responsive to estrogen or progesterone), they were not concerned about the fertility treatments causing me any more harm. The treatment is extremely expensive and the process isn’t the easiest from an emotional and, in some cases, a moral standpoint for some people. I am single and I must say that dating post breast cancer diagnosis and mastectomy has me with some concern, but I know I’m not alone.”