Fertility after Cancer
Worry about infertility is a major issue for many younger women who are diagnosed with breast cancer. We know that chemotherapy often terminates menses in women who are in their 40s or older, and, sometimes, this happens with younger women. Sometimes the medical hope is that ovarian function (and the resulting estrogen) be suppressed when the tumor is ER positive. The addition of Tamoxifen after chemotherapy can reduce estrogen even more and the treatment is generally for five years. This delays the question of babies even longer. Sometimes, younger women who continue to menstruate after chemotherapy are given Lupron (or another agent) to close down their ovaries. All of this adds up to a delay, maybe a long delay, in thinking about pregnancy and a likely diminishment, or end, of fertility.
Since many women have delayed having babies due to professional and personal choices and concerns, the number of women with breast cancer and unfinished families continues to increase. Sometimes, you can grieve just as much for what you will never have as for what you have lost. Losing the dream, even realizing that you may have to give up the dream, of children is heartbreaking.
On the other hand, I have seen a real change in the medical view of pregnancy after breast cancer. Thirty, even twenty, years ago, women were warned that a pregnancy could be dangerous and cause their cancer to recur. Most oncologists now believe that, in most situations, this is not the case, and many women go on to have healthy pregnancies and healthy babies after breast cancer. I know many of them.
Here is the abstract from an article in Critical Reviews in Oncology Hematology from Tomao and colleagues at the University of Rome. After the abstract, I will post a link if yo are interested in reading more:
Ovarian function, reproduction and strategies for fertility
preservation after breast cancer
Federica Tomaoa,b, Gian Paolo Spinelli b, Pierluigi Benedetti Panici a,
Luigi Frati b, Silverio Tomaob,!
There is strong evidence that infertility is a dramatic and frequent side effect in men and women of childbearing age who are undergoing chemotherapy for their cancer treatment. This, severe and often underestimated complication heavily deteriorates the quality of life of affected patients and risks to reduce the therapeutic efforts and the compliance towards the suggested treatments. Moreover, cancer related infertility is still considered a marginal aspect of the quality of life in cancer patients. Reproduction's preservation plays today an emerging role in the culture of industrialized countries and moves extraordinary interests from the scientific and economic points, of view. Unfortunately medical oncologists, surgeons and gynaecologists have little consideration, for this complication and often possess a limited knowledge about the clinical aspects of cancer, related infertility and the possibilities of prevention and treatment of cancer related gonadic failure.
Since more young people are offered adjuvant treatments at earlier stages of cancer, the problem of, chemotherapy related gonadic toxicity has considerably increased in the last years. It is also important to consider the new opportunity derived from the assisted reproductive techniques available. From this point of view the treating physicians need to be able to make accurate assessments of risks and benefits of antineoplastic treatments in order to schedule the best approach to and to preserve the possibility of reproduction in their young patients. These aspects are more relevant in breast cancer patients, mainly in the early phase of the disease, due to the high probability to retain reproductive possibilities also after aggressive and integrated therapies.