Preserving fertility and breast cancer

Breast cancer treatment, such as chemotherapy might affect your fertility. Some women can get pregnant naturally after their cancer treatment. But other women find they are unable to have children after treatment. Men who have breast cancer treatment may also have fertility problems.

Your diagnosis might mean you have to think about your fertility earlier than you had planned. And having treatment that affects whether you can have children can be very difficult to cope with. Some women find this as difficult to come to terms with as their cancer diagnosis.

Talk to your doctor about your fertility before your cancer treatment. Your team are there to help you find a balance between treating your cancer and wanting to have children. National guidelines for doctors say that they should discuss how your cancer and its treatment might affect your fertility at diagnosis.

Doctors are interested in new ways of preserving fertility for people with breast cancer. Research is ongoing to find out how well they work and how safe they are.

Freezing embryos and IVF

At the moment, in vitro fertilisation (IVF) is the most effective way of preserving fertility. You take hormones to stimulate your ovaries to make eggs. A doctor removes the eggs and fertilises them with sperm in the laboratory. This creates an embryo. It's possible to use donor sperm if you don’t have a male partner at this stage.

The embryo can be frozen and stored. After treatment, the doctor puts one or more of the embryos into your womb to try to make you pregnant.

Making your ovaries release eggs

This is called ovarian stimulation. There are several different ways of collecting an egg or eggs to be able to do IVF. Some of these include:

• natural cycle IVF – this means using no hormones to help you produce more eggs. With this type of IVF your doctor collects the one egg you release with your normal monthly cycle
• mild stimulation IVF  – you have a lower amount of hormones over less time to help you release more than one egg
• using hormone therapies  such as aromatase inhibitors  either on their own or in combination with a lower dose of IVF hormones. The drugs you might have include letrozole or tamoxifen

A disadvantage of freezing embryos is that it takes time and could result in a delay to your cancer treatment.

Talk to your doctor about whether having IVF could be a possibility. It's available for some people on the NHS but not in all parts of the country. IVF and freezing embryos are not always successful and the number of treatments you can have varies from area to area. You need to check with your doctor to find out what is available for you.

Freezing eggs

Doctors are able to take out and freeze women’s eggs. The process is very similar to IVF. You might prefer this method if you have no male partner and don’t want to use donor sperm.

Again, you need hormones to stimulate the ovaries to produce the eggs, which are collected and frozen. This takes about 2 to 3 weeks. When you want to use the eggs they are thawed and injected with sperm to fertilise them. The problem is that freezing and thawing eggs seems to damage them. So the process does not always result in a pregnancy. 

Talk to your doctor to see if this is available in your area and if it is safe to do before starting treatment.

Ovarian tissue freezing

You can have a small operation to remove some ovarian tissue, which is then frozen. This is called ovarian tissue cryopreservation. The tissue is put back once your cancer treatment has finished.

If the ovarian tissue starts working normally, the ovaries may produce eggs. This allows you to try naturally for a baby.

This is a new treatment that is still in development.

Ovarian tissue cryopreservation services aren’t available everywhere but they are increasing across the UK. Ask your specialist if this is suitable for you and whether they can refer you to one of these services. 

Reducing the impact of chemotherapy on fertility

Some chemotherapy drugs permanently stop the ovaries from producing eggs. If this happens, you can no longer get pregnant and you may have menopausal symptoms.

Some chemotherapy drug combinations, such AC are less likely to affect your fertility than others, such as CMF.

Having AC doesn’t mean treatment definitely won’t affect your ovaries, but the risk is smaller. If you are over 40 there is a greater risk of fertility problems with any chemotherapy.

Researchers are also looking into using hormone treatment to protect the ovaries from chemotherapy. This means having injections of hormones called luteinising hormone blockers (LH blockers), for example goserelin (Zoladex), while you're having chemotherapy.

The aim is that the LH blockers stop your ovaries working during the time you have treatment. Once you finish treatment you stop the injections and your ovaries start working again. The evidence so far is mixed and we need more research to find out whether this does preserve fertility.

Sperm banking

Some cancer treatments can affect your ability to father children naturally.

Collecting sperm before treatment means you might still be able to have children in the future if you want to. The sperm is frozen and stored until you decide you want to use it to have a baby.

This is called sperm banking or sperm cryopreservation.

That Cancer Conversation

That Cancer Conversation is Cancer Research UK's podcast. In the episode exploring infertility and cancer, we chat with people whose cancer journey has had an impact on their fertility.

It also features Professor Richard Anderson, Deputy Director of the University of Edinburgh’s Centre for Reproductive Health. We explore options that are available and what the future of fertility medicine could look like.