Babes and Breasts

Dr. Jillian Morgan | July 11th, 2014
Dr. Jillian Morgan

Dr. Jillian Morgan

Hello my healthies! After the March article on cancer entitled “Cancer is a bad…shut your mouth,” I received a question about breast cancer and fertility. The reader wanted to know if treatments for breast cancer would affect their fertility and if there were options for preserving fertility so they may have children in the future.

A person’s first reaction to a diagnosis of breast cancer may understandably be anger, sadness and depression. For many young women diagnosed with breast cancer, these feelings may be coupled with uncertainties about fertility. According to the American Cancer Society, 25 percent of new breast cancer cases are in women of childbearing age. However, with the strides that have been made in cancer research, women diagnosed with breast cancer are living longer and more productive lives. Breast cancer is no longer a death sentence! Treatment options have expanded to focus not only on survival but quality of life as well. Future fertility is a major concern for a lot of women diagnosed with breast cancer. There are many avenues young women with breast cancer can explore to preserve fertility.

The current therapies for the treatment of breast cancer include surgery, radiation and chemotherapy. Surgery does not affect fertility and radiation has little to no affect. However, chemotherapy can greatly reduce a breast cancer patient’s fertility. The extent of the detrimental effects that chemotherapy will have on a woman’s fertility depends on the age of the patient, the specific chemotherapeutic agent used and the total dose of that agent. Chemotherapeutic agents cause infertility due to their harmful affects on the ovaries. As you may know, the ovaries are the organs that produce and house a female’s eggs until they are released during ovulation. While chemotherapeutic drugs produce their desired effects by killing cancer cells, they also kill normal cells in the process. Some of the normal cells that are affected are the woman’s reproductive eggs. It is important to note that chemotherapy can cause a more rapid loss of eggs than the decrease that normally occurs over time. You see, women are born with a certain number of eggs and as we age, this number decreases. Coupled with the natural decline in reproductive eggs, the effects of chemotherapy on the ovaries in older women are more pronounced and leading to an increased chance of infertility. However, in the case of younger women, there is a better chance of maintaining fertility after chemotherapy due to a larger supply of eggs that still remains. Because of these reasons, the risk of infertility is largely dependent on the age of the patient.
Research has shown that certain chemotherapeutic drugs are more likely to result in infertility than others. The most common chemotherapy used for the treatment of breast cancer is CMF which consists of cyclophosphamide, methotrexate, and 5-fluorouracil. Alkylating agents, which are a common class of drugs used in the treatment of cancer and are the most toxic agents to the ovaries and a woman’s fertility.

Cyclophosphamide is one example of an alkylating agent. Methotrexate and fluorouracil, on the other hand are thought to have minimal effects on the ovaries and ultimately the patient’s fertility. Not only is the specific drug that is used as a factor in infertility, the total dose of that drug is also a factor. The higher the dose and the longer the length of administration, the greater the damage that is done to the ovaries.

There are options for women who have been diagnosed with breast cancer and would like to have children in the future. These options include embryo freezing, also known as embryo cryopreservation, freezing eggs (oocyte cryopreservation), and ovarian cryopreservation. Embryo cryopreservation involves extracting the eggs from the female patient, fertilizing them outside the body and freezing the fertilized eggs or embryos until the woman is ready to become pregnant. Oftentimes, prior to extracting the eggs, the woman is given fertility drugs to increase the number of eggs that can be produced. However, it may not be a good idea to give women diagnosed with breast cancer fertility treatments. The reasoning is because these treatments increase estrogen production which may stimulate the growth and metastasis of the existing cancer. However, in the absence of the fertility treatments, only one or two eggs may be extracted and preserved per cycle. If fertility treatments are necessary, a short course of high dose tamoxifen may be most beneficial for breast cancer patients. Tamoxifen will increase the production of eggs while minimizing the risk of breast cancer growth and metastasis. Once the woman has completed chemotherapy, she should speak with her oncologist about when it is safe to utilize the embryos for pregnancy.

An additional therapy that can be used is the freezing of the patient’s eggs. In this procedure, the eggs are harvested in the same manner as embryo freezing. Oocyte cryopreservation may be a viable option for women who do not have a significant other nor wish to use a sperm donor. These eggs are frozen without being fertilized. They are stored until the woman is ready to become pregnant. To date, the number of live births utilizing this method has been few; however major advances have been made in perfecting this technique.

An experimental method that is also used to preserve fertility is the freezing of ovarian tissue, a procedure known as ovarian cryopreservation. In this procedure, a woman’s entire ovary or a slice of ovarian tissue containing eggs is removed prior to chemotherapy. This ovarian tissue is frozen until the woman is ready to become pregnant. Once that time has arrived, the tissue is implanted in the pelvis or arm of the woman. Over time, blood vessels nourish the tissue and eggs begin to develop and mature. The mature eggs are then removed and fertilized. After fertilization, the embryo is implanted in the woman’s uterus and she is able to carry the baby to full term.

It is understandable that the thought of breast cancer is marked by mixed emotions. However, for the woman with a maternal instinct, the focus does not have to be on grim fertility outcomes. There are multiple interventions that have been researched to decrease the chance of infertility and increase the possibility of pregnancy. If having children is a concern, you should speak with your oncologist and a fertility specialist prior to undergoing breast cancer treatment. They will be able to advise you about the best options to protect your fertility. So, as always, I encourage you to GET YOURx LIFE— speak to your physician about the best treatment for you and your babies!

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