Fertility and Pre-Menopausal Breast Cancer

  1. Early integration of assessment and counseling regarding preservation of fertility is an essential part of the multidisciplinary treatment of pre-menopausal breast cancer patients- a fertility specialist must be involved early on after diagnosis
  2. Chemotherapy is generally associated with loss of period during treatment. There is also an increased chance of infertility although the mechanism is not clearly understood
  3. Chemotherapy induced menopause is directly related to age at diagnosis and length of treatment. So the closer to 40 you are, the more likely you are to have chemotherapy-induced menopause.
  4. Many young women will regain their period after finishing chemotherapy. Resumption of menstruation, however, is not always correlated with fertility.
    Tamoxifen can cause loss of period as well and again it seems to be related to age. Many women do regain their period on Tamoxifen however. Tamoxifen does have the potential to induce ovulation and it can cause birth defects so pre-menopausal women should be educated on non-hormonal methods of birth control
  5. There are several ongoing clinical trials examining protection of ovarian function in pre-menopausal breast cancer patients by inducing ovarian suppression with medications. The results of these studies have not been released yet but it is certainly something that a fertility specialist and/or medical oncologist should discuss with you
  6. Embryo and egg cryopreservation are the two fertility options offered the majority of the time to pre-menopausal women with breast cancer who are going to receive systemic therapy. Frozen embryo (fertilized eggs) transfers are generally more successful than frozen egg harvesting
  7. There are some studies looking at preserving strips of ovary for re-implantation at a later time
  8. Fertility preservation can delay the time between surgery and medical therapy but it is usually an acceptable amount of time with little effect on survival
  9. Concerns have been raised about the transient increase in estrogen and progesterone levels with egg/embryo harvesting. There has not been a study to date clearly linking ovulatory inducing drugs with breast cancer. At some institutions, an aromatase inhibitor is given with ovulation induction medications to protect the breasts, especially in women with estrogen positive tumors.
  10. Pregnancy after breast cancer treatment is safe. Although there have not been any randomized trials to look at post-treatment pregnancy, several retrospective and observational studies have shown no increase in breast cancer recurrence with pregnancy. Some studies suggest there may even be a protective effect

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