REPOST: Breast Cancer's Dirty Little Secret: Fertility Loss

How does breast cancer affect one's future offspring? This Health.com article elaborates the risks posed by cancer treatments and ways on how they might affect fertility.

Image Source: health.com

I recently edited a story for Health magazine about what it’s really like to have breast cancer. The survivor stories were both inspiring and heartbreaking. But the women who haunted me most were those who were not only worrying about staying alive, but about whether they could get pregnant.

"Learning that I may not be able to have a baby was the hardest thing I had to deal with," says Stephanie Gensler, a 39-year-old ad executive who was diagnosed with stage II aggressive breast cancer at age 34. She underwent a lumpectomy, six months of chemo, and 36 radiation treatments. "My doctor says it's possible," says Gensler, "but I’m not sure it is."

That kind of uncertainty drove many women to a recent Web seminar hosted by BreastCancer.org on breast cancer and fertility. Their questions were wide-ranging:

I’m having chemotherapy treatment for six months. Can I still hold out hope for a pregnancy after treatment? Does insurance pay for freezing my eggs if I have breast cancer? If I do get pregnant, will my child have a higher risk of breast cancer? Fertility experts answered them: Kutluk Oktay, MD, a professor of obstetrics and gynecology and the director of the Division of Reproductive Medicine & Infertility at New York Medical College; and psychologist Leslie R. Schover, PhD, a professor of behavioral science at the University of Texas M.D. Anderson Cancer Center in Houston, who helps cancer survivors make decisions about fertility preservation, cope with fertility-related distress, and resolve cancer-related sexual problems.

There is good news

There have been great advances in the fertility-after-breast-cancer field—from freezing embryos (fertilized eggs) and oocytes (unfertilized eggs) for later in vitro fertilization, to experimental procedures such as removing and freezing some ovarian tissue so that it can be re-implanted once treatment has been completed. Dr. Oktay pioneered some of these developments as founder of the Institute for Fertility Preservation at the Center for Human Reproduction in New York City.

But for some, it’s too late

Most of the women getting the information via the Web seminar were getting it way too late. It was painful to see these women's fertility hopes dashed because they had already undergone treatment that put them into permanent early menopause or otherwise compromised their ability to conceive.

When one woman undergoing chemotherapy asked if she would be able to get pregnant afterward, Dr. Oktay said, "If you’re receiving one of the standard chemotherapy regimens...your ovaries will behave after chemotherapy as if you’re in your 40s. And based on my experience and studies, you will have a very small chance of conceiving. If there’s a possibility, any woman in this situation should consider freezing eggs or embryos before treatment has begun."

That means it’s critical for women to get this information before they undergo treatment, and many don't.

"I didn’t get it," says Stephanie Gensler, who wishes someone had put egg preservation on her radar. "No one said anything about it, and I wasn’t thinking about it."

Finding out what you need to know 

Since oncologists are focused on saving lives first, and fertility second, breast cancer survivors need to find other sources of information to fill the void.

FertileHope.org offers reproductive information and support to cancer patients and survivors whose medical treatments present the risk of infertility.

The American Cancer Society offers comprehensive information on preserving fertility in men and women who undergo treatment.

MyOncoFertilty.org intersperses the advice of experts with much-needed friendliness, such as comforting videos from survivors like Laurie.

"When I met with my oncologist the first two times, I didn’t even think to ask her about fertility. It was all about me. It was about saving my life," says Laurie. She was lucky to get fertility advice after her mastectomy but before her chemotherapy began, and she is now pregnant. That’s the kind of happy ending that I hope we’ll be hearing more of in the future.

Dr. Cristian Andronic is known for his expertise in all aspects of general gynecology and obstetrics. More links to articles on women's health, pregnancy, and child birth are available on this Facebook page.