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A breast cancer diagnosis can be overwhelming, particularly if you may want children in the future or are considering starting or growing a family. While cancer treatment needs to remain the priority, some breast cancer treatments can significantly affect fertility.
For women diagnosed during their reproductive years, fertility preservation should be discussed as soon as possible after a breast cancer diagnosis. There may be a short window between diagnosis and starting chemotherapy when options such as egg freezing can be considered. Cancer treatment is always prioritised however fertility preservation can be done in a short period of time.
At Stellar Fertility, urgent fertility preservation appointments can be arranged with Dr Rachael Knight within a day or two of diagnosis to help patients understand their options and coordinate fertility treatment around their cancer treatment plan.
Fertility preservation refers to treatments that aim to protect or preserve a person’s reproductive potential before medical treatment that may affect fertility. In the context of breast cancer, this is often referred to as medical fertility preservation. For women who may want children in the future, fertility preservation may involve freezing eggs before chemotherapy or considering other approaches to help protect ovarian function. The important distinction is the timing. While elective egg freezing may be something someone considers over a longer period of time, fertility preservation following a cancer diagnosis can be time-sensitive and urgent.
The greatest impact on fertility generally comes from breast cancer treatment rather than the cancer itself. Chemotherapy can reduce the number of eggs remaining in the ovaries. Some chemotherapy agents are particularly damaging to ovarian reserve. Dr Rachael Knight explains that cyclophosphamide, a chemotherapy medication commonly used in the treatment of breast cancer, can cause a significant reduction in egg numbers. For some women, this reduction can be severe enough to result in permanent menopause. Breast cancer can also indirectly affect future fertility because it may mean that plans to have children need to be put on hold while someone undergoes treatment and recovers. Egg numbers and egg quality naturally decline with age. If having children needs to be postponed for several years because of cancer treatment and recovery, this natural decline in fertility also needs to be considered and can have a significant impact.
Fertility preservation should ideally be discussed as soon as possible after a breast cancer diagnosis. Cancer treatment is often planned relatively quickly, however there may be a window of approximately two to four weeks between diagnosis and the commencement of chemotherapy. This period can provide an opportunity to see a fertility specialist, discuss the potential impact of treatment on fertility and, where appropriate, undertake fertility preservation. Importantly, fertility preservation is not intended to take priority over cancer treatment. The fertility team works around the oncology treatment plan. The aim is to maximise reproductive options while ensuring that cancer treatment can proceed as planned. Even when treatment needs to begin very quickly, it is still worth speaking with a fertility specialist. There may be fertility preservation options available even when there is insufficient time for a conventional egg freezing cycle.
Egg freezing is one of the most established fertility preservation options. The ovaries are stimulated to encourage the development of multiple eggs. The eggs are then collected and frozen for potential use in the future. The timing of treatment needs to be coordinated carefully with the patient’s oncology team.
Another option that may be considered is treatment with a medication called a GnRH agonist, such as goserelin (Zoladex). This medication temporarily suppresses ovarian activity during chemotherapy. The aim is to reduce the impact of chemotherapy on the ovaries and potentially reduce the likelihood of significant loss of ovarian function. Ovarian suppression may be administered by a fertility specialist or oncologist and can sometimes be used alongside egg freezing.
Ovarian tissue preservation is another fertility preservation option. This involves removing and freezing ovarian tissue for potential use in the future. It may be particularly relevant when there is very little time available before cancer treatment needs to commence. Ovarian tissue preservation requires specialist assessment and may involve referral to a specialised centre with expertise in this area.
The most appropriate fertility preservation approach will depend on factors including the person’s age, cancer treatment plan, ovarian reserve and the amount of time available before treatment.
Some people are found to have a genetic increased risk of developing breast and other cancers. This can include mutations in the BRCA1 and BRCA2 genes, among others. For someone with a known genetic cancer risk, fertility and reproductive planning may form part of a broader discussion about their future. If IVF is being considered, pre-implantation genetic testing (PGT) can sometimes be used to test embryos for a specific genetic condition. This can help identify embryos that do not carry the particular genetic mutation being tested for before an embryo is transferred. Because not every embryo will necessarily be suitable for transfer, having a larger number of eggs available may be beneficial when PGT is being considered. Fertility preservation may therefore be relevant not only for women who have already been diagnosed with breast cancer, but also for some women who discover they carry a genetic mutation that increases their cancer risk and are considering future risk-reducing treatment.
There is no age that is considered too young to have a conversation about fertility preservation following a breast cancer diagnosis. Breast cancer can occur in younger women, including women in their twenties. If someone is diagnosed during their reproductive years and may want children in the future, fertility preservation should be discussed regardless of whether having children is an immediate priority. The purpose of an early consultation is not to pressure someone into freezing their eggs. It is to ensure they understand how their treatment may affect their future fertility and what options may be available to them now and in the future.
A referral for fertility preservation following a breast cancer diagnosis is considered urgent. At Stellar Fertility, Dr Knight aims to see patients within one to two working days, allowing the fertility team to assess their circumstances and discuss their options as quickly as possible. The fertility team can work alongside the patient’s oncology team to determine whether egg freezing, ovarian suppression, ovarian tissue preservation or another approach may be appropriate. Where there is a short window before chemotherapy, acting quickly can provide more opportunities to consider fertility preservation.
If you have recently been diagnosed with breast cancer and may want children in the future, contact Stellar Fertility Melbourne for an appointment.
You do not need to have all the answers before your appointment. The first step is understanding how your treatment may affect your fertility and what options may be available to you.
Yes. Some chemotherapy medications can significantly reduce the number of eggs remaining in the ovaries. In some women, the reduction in ovarian function can result in permanent menopause.
The primary impact on fertility generally comes from the treatment for breast cancer, particularly chemotherapy. However, the diagnosis can also affect future fertility indirectly if plans to have children need to be postponed during treatment and recovery.
As soon as possible. Fertility preservation is time-sensitive because cancer treatment may need to begin within a matter of weeks. At Stellar Fertility, urgent appointments aim to be arranged within one to two working days.
Fertility preservation is not prioritised over cancer treatment. The fertility team works around the oncology treatment plan to determine what options can be undertaken without delaying cancer treatment.
It is still worth discussing your options with a fertility specialist. While there may not be enough time for a conventional egg freezing cycle, other approaches, including ovarian suppression or ovarian tissue preservation, may be considered depending on your individual circumstances. Egg freezing may also be deferred until after the first steps of cancer treatment.
No. Egg freezing is one option. Ovarian suppression with a GnRH agonist and ovarian tissue preservation may also be considered in appropriate circumstances.
Yes. A young age does not mean fertility preservation is unnecessary. Younger women can be diagnosed with breast cancer, and if having children in the future is something you may want, it is worth discussing your options before treatment begins.
If you carry a genetic mutation associated with an increased cancer risk, fertility preservation and future reproductive planning may be worth discussing. If IVF is being considered, pre-implantation genetic testing may also be an option for identifying embryos that do not carry the specific genetic mutation being tested for, thus reducing the risk for your children.
No. You do not need to have decided whether you definitely want children. An early fertility consultation can simply help you understand how cancer treatment may affect your reproductive options, allowing you to make an informed decision about the future and expanding your chances of future fertility should you want to.
