Breast cancer: Infertility and premature menopause

Of the 46,000 women diagnosed with breast cancer in the UK each year, about 25% have not yet reached the menopause. Some chemotherapy and hormone therapy drugs used to treat breast cancer can cause permanent or temporary infertility or premature menopause. This is a concern for women who are still interested in having children. If this applies to you, you should search out ways to preserve your fertility before beginning cancer treatment. Even if you are not menstruating, pre-menopausal women should still use contraception while undergoing such therapies because some chemotherapy drugs are associated with birth defects.

Learning about premature menopause and getting support from your doctor or specialist nurse can help women anticipate and deal with the symptoms of the menopause.

Radiotherapy will not cause infertility unless it is directed at both ovaries. Sometimes the ovaries may be surgically removed or irradiated to reduce the amount of oestrogen produced. This will cause permanent infertility.

Following chemotherapy, a woman may experience irregular functioning of the ovaries for months or even years. Ovarian function may return to normal depending on a woman’s age and the type of chemotherapy used.

Options for preserving fertility

Women with breast cancer who wish to start or expand a family should consider options to preserve fertility before undergoing cancer treatment. This is not always possible and it is important for women to discuss this with their doctor or specialist nurse. Patients are often overwhelmed by their diagnosis and are most concerned at first with treating the cancer.

Techniques to preserve fertility include:

• Freezing and storing embryos: here, a woman’s eggs are collected before any breast cancer treatment starts. These eggs are then fertilised and the resultant embryos are frozen and stored for future use (IVF).
• Freezing and storing eggs: unfertilised eggs are frozen and stored.  In the future, they can be thawed and fertilised. This is less successful and more experimental than embryo freezing.
• Using donor eggs: here, a woman could receive eggs from an egg donor, which could then be fertilised and implanted once cancer treatment is completed.
• Freezing and storing ovarian tissue: some ovarian tissue is removed prior to breast cancer treatment and is then frozen and stored. At a later date, after treatment, doctors could replace the ovarian tissue in the hope that it might produce eggs. This procedure remains experimental.