Breast Cancer: Protecting Fertility

In many cases, treatment for breast cancer involves chemotherapy, radiation therapy, or a combination of the two. These treatments can affect your reproductive system and, as a result, your fertility.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs work by attacking rapidly dividing cells, such as cancer cells. However, these drugs also kill some healthy cells, including those involved in the production of eggs, which also divide rapidly. The type of chemotherapy drug or drugs used, the length of treatment, and the person's age at the time of treatment are all factors that can affect fertility. In some cases, the effect of chemotherapy on fertility is temporary, but it can be permanent.

Radiation therapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. Radiation kills cancer cells by interfering with their growth and division. The potential for fertility problems brought about by local radiation therapy for breast cancer is not as great as for chemotherapy because the area affected by cancer is away from the reproductive organs. However, because radiation beams often pass through healthy tissues, the organs near the cancer site may be affected by the radiation, which can lead to either temporary or permanent infertility. Radiation to the pelvic region may impair fertility.

Factors that affect sexual desire can also be a problem for someone who may want to become pregnant. For example, a decreased sex drive is a possible complication of breast cancer treatment. This may result from hormonal changes caused by the treatment or from fatigue that often accompanies cancer therapy.

In addition, breast cancer pain or treatment -- especially chemotherapy -- can cause nausea. Self-image may also be a problem. Breast cancer and its treatment may leave physical and emotional scars. Time and counseling may help overcome the mental and emotional side effects of breast cancer.

Be sure to discuss your concerns about fertility with your doctor before you begin breast cancer treatment.

Can fertility be preserved after treatment for breast cancer?
There are ways for breast cancer patients to increase their chances of having children following treatment.

• Cryopreservation. Cryopreservation is the process of freezing and storing embryos (fertilized eggs) for later use. This involves first stimulating the ovaries to make mature eggs (oocytes) that can be retrieved and fertilized. The embryos can be implanted in the woman after she recovers from breast cancer treatment or in a surrogate (a woman who carries the baby when the natural mother is unable). Unfertilized eggs are more delicate and can be easily damaged during the freezing process. For this reason, cryopreservation of unfertilized eggs is less effective.

  Improvements in the techniques of assisted reproduction -- such as in vitro fertilization (a procedure in which thousands of sperm are placed in a laboratory dish with an egg) and intracytoplasmic sperm injection (a procedure in which a sperm is injected directly into an egg) -- have increased the production of usable embryos for cryopreservation.

• Freezing ovarian tissue. One ovary is generally removed and frozen for later use.
• Use of less toxic chemotherapy drugs. While some chemotherapy drugs may cause less damage to the reproductive organs, these drugs may also be less effective at treating breast cancer. Your oncologist can determine if a less toxic chemotherapy drug is appropriate for your cancer treatment.

Researchers also are looking at new methods of treatment that spare the reproductive system. These include the following:

• Hormonal suppression of the reproductive organs. This approach involves using hormones to place the reproductive organs in a dormant (inactive) state, shutting down your body's production of eggs. This process seems to protect the cells that develop into eggs (germ cells) from damage by chemotherapy. This approach is still considered investigational.