Serena Dovey, MD., Spring Fertility
How will my fertility be impacted if I am diagnosed with breast cancer prior to having the family I desire?
In one year, approximately 26,400 women will be diagnosed with breast cancer under the age of 45 in the US (and of those, 12,150 will be under age 40). For women diagnosed with breast cancer in their reproductive years who have not yet finished having children, fertility concerns related to treatment are often paramount.
Treatment for breast cancer in young women often involves adjuvant or neoadjuvant chemotherapy which can have a negative impact on ovarian reserve (aka, the number of eggs that remain in the ovary). Additionally, given that fertility is already naturally declining in the mid-late 30s, and treatment for breast cancer may delay a woman’s ability to try to conceive for at least 1-2 years, the risk for infertility in women diagnosed with breast cancer in their 30s and 40s is significant.
Luckily, fertility preservation options, including egg or embryo banking, can help extend a woman’s timeframe for conception and improve the odds of having the family she desires. A banking cycle can be initiated rapidly and studies have shown that there is no significant delay in starting cancer treatment between women who do and do not undergo egg or embryo banking. 1, 2
What should I consider if I have a BRCA mutation?
For those women who are known to be BRCA carriers, medical recommendations include undergoing removal of the ovaries and fallopian tubes to help reduce the risk of ovarian cancer (this procedure is called a prophylactic BSO). For women with BRCA1 mutations specifically, it is often recommended that they consider prophylactic BSO by age 35. For women with BRCA1 mutations who may not yet have completed having the family they desire by age 35 but want to undergo prophylactic BSO to reduce their risk of ovarian cancer, egg or embryo banking could be considered to preserve fertility. Moreover, women with BRCA mutations may choose to undergo IVF to conceive even if timing is not a factor, because it is possible to screen embryos created through IVF for the BRCA mutation to avoid passing this genetic condition on to children. This involves doing genetic testing called preimplantation genetic testing for a monogenic disorder, or PGT-M, on each embryo created through IVF to see if it would carry the BRCA gene.
Does going through IVF increase my risk of getting breast cancer in the future?
Another commonly asked question related to breast cancer and fertility is whether fertility treatments, such as IVF, can increase the risk of developing breast cancer later in life. Reassuringly, large studies addressing this question have shown that women who undergo IVF do not appear to have an increased risk of developing breast cancer. 3, 4, 5 The most recent of these studies, published in 2017, evaluated over 1.8 million women in the Netherlands born between 1960 and 1992 and concluded that the incidence of breast cancer was not increased among women who underwent IVF or received any hormonal fertility treatment compared to those who did not. 5
Please feel free to schedule a consultation with one of the physicians at Spring; we are happy to address any specific questions or situations regarding your personal medical history and how it may impact fertility.
1 Pavone M, et al. Fertility preservation (FP) in breast cancer patients does not delay time to cancer treatment. Fertility and Sterility 2017: 108(3): E184.
2 Letourneau J, et al. Fertility preservation does not prolong neoadjuvant chemotherapy start but patients still perceive a delay. Fertily Steril 2017: 108(3): E31-32.
3 Sergentanis TN et al. IVF and breast cancer: a systemic review and meta-analysis. Human Reproduction Update 201: 20(1): 106-123
4 Van den Belt-Dusebout AW et al. Ovarian stimulation for In Vitro and long-term risk of breast cancer. JAMA 2016: 316(3): 300-312.
5 Lundberg, FE et al. Ovarian stimulation and risk of breast cancer in Swedish women. Fertility and Sterility 2017: 108(1): 137-144.