Metastatic breast cancer (MBC) can cause a woman to lose her ability to have children with her own eggs. This diagnosis can also delay the timing of when a woman can become pregnant.
One reason is that after starting treatment, doctors usually ask women to wait years before pregnancy because of the risk of recurrence. The other reason is that treatment for MBC can cause early menopause. These two issues lead to a decrease in fertility rates in women who have MBC.
Women are born with all the eggs we’ll ever have, but as time passes, we run out of viable eggs. Unfortunately, age is the enemy of fertility.
For example, if you’re diagnosed with MBC at age 38, and told you can’t become pregnant until age 40, you’re starting or growing your family at an age when your egg quality and chances for a natural conception are much lower. On top of that, MBC treatment can also affect your egg counts.
Treatments for MBC can lead to early menopause. Depending on your age at diagnosis, this could mean a lower likelihood of a future pregnancy. This is why it’s so important for women with MBC to consider fertility preservation before starting treatment.
Chemotherapy drugs can also cause something called gonadotoxicity. Simply put, they can cause eggs in a woman’s ovary to become depleted faster than normal. When this happens, the eggs that are left have a lower chance of turning into a healthy pregnancy.
Fertility preservation methods for women with MBC include egg freezing and embryo freezing. It’s important to talk a fertility specialist about these methods before starting chemotherapy or undergoing reproductive surgery.
Ovarian suppression with a medication called a GnRH agonist may also preserve ovarian function. You may have also heard or read about treatments like retrieving and preserving immature eggs and ovarian tissue cryopreservation. However, these treatments aren’t readily available or reliable for women with MBC.
This is a question that depends on the treatments you’ll need and your specific case of MBC. It’s important to thoroughly talk this through with your doctors to weigh your options before making a decision.
Researchers are also trying to answer this question through the POSITIVE trial. In this study, researchers are recruiting 500 premenopausal women with ER-positive early stage breast cancer. After a 3-month treatment break, women will stop treatment for up to 2 years to become pregnant. After that time, they can restart endocrine therapy.
At the end of 2018, over 300 women had enrolled in the study and nearly 60 babies had been born. Researchers will follow up with the women for 10 years to monitor how they’re doing. This will allow researchers to determine if a break in treatment can lead to a higher risk of recurrence.
A woman’s chance for a successful pregnancy is related to a couple of factors, including:
- anti-Mullerian hormone (AMH) levels
- follicle count
- follicle-stimulating hormone (FSH) levels
- estradiol levels
- environmental factors
Getting a baseline assessment before MBC treatment can be useful. This assessment will tell you how many eggs you can possibly have frozen, whether to consider freezing embryos, or if you should do both. I also recommend monitoring fertility levels after treatment.
In order for MBC patients to maximize their chances of future pregnancy, it’s important to seek early counseling and referral to a fertility specialist.
I also tell my patients with cancer to see a family law attorney to create a trust for your eggs or embryos in case something happens to you. You may also benefit from talking to a therapist to discuss your emotional health throughout this process.
Women who didn’t preserve their fertility before cancer treatment can still get pregnant. Risk of infertility has to do with your age at the time of your diagnosis and the type of treatment you receive.
For example, a woman who was diagnosed at age 27 has a higher chance of having eggs left after treatment compared to a woman diagnosed at age 37.
Menopausal pregnancy is possible. While it may seem like those two words don’t go together, they actually can. But the chance for a pregnancy conceived naturally without the help of a fertility specialist after premature menopause from treatment is low.
Hormone therapy can get a uterus ready to accept an embryo, so a woman can have a healthy pregnancy after she has gone through menopause. A woman can use an egg she froze prior to treatment, an embryo, or donated eggs to get pregnant. Your pregnancy chances are related to the health of the egg or embryo at the time it was created.
Dr. Aimee Eyvazzadeh of the San Francisco Bay Area has seen thousands of patients deal with infertility. Preventative, proactive, and personalized fertility medicine is not only what she preaches as part of her weekly Egg Whisperer Show, but it’s also what she practices with the hopeful parents she partners with each year. As part of a mission to make people more fertility aware, her care extends well beyond her office in California to people all over the world. She educates on fertility preservation options through Egg Freezing Parties and her live-streaming weekly Egg Whisperer Show, and helps women understand their fertility levels through Egg Whisperer Fertility Awareness panels. Dr. Aimee also teaches her trademarked “TUSHY Method” to inspire patients to understand the full picture of their fertility health before starting treatment.