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Protecting fertility during breast cancer treatment

Chemotherapy, radiotherapy and other breast cancer treatments can affect a woman's fertility.

This can be temporary, or permanent, and the treatment may also bring on an early menopause.

This can be a concern for woman who wants to have children. If fertility is a concern, make sure your breast cancer care team knows this before treatment begins.

They may be able to make a referral to a fertility clinic. Options include freezing eggs, freezing ovarian tissue, and IVF techniques.

How breast cancer treatments affect fertility

Chemotherapy is the use of drugs to kill cancer cells that divide rapidly. 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.

Radiotherapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. Radiotherapy kills cancer cells by interfering with their growth and division. The potential for fertility problems due to radiotherapy are 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.

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 counselling may help overcome the mental and emotional side effects of breast cancer.

Discuss your concerns about fertility with your doctor before you begin breast cancer treatment.

Can fertility be preserved after breast cancer treatment?

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 (fertilised eggs) for later use. 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. Unfertilised eggs are more delicate and can be easily damaged during the freezing process. For this reason, cryopreservation of unfertilised eggs is less effective. Improvements in the techniques of assisted reproduction, such as in vitro fertilisation (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.
  • 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.
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