There are a couple of key pieces of information for every breast cancer patient who may desire fertility after her diagnosis. Firstly, before beginning any therapy that may limit your ability to become pregnant, such as chemotherapy or anti-hormonal therapy, you should have the chance to speak with a reproductive endocrinologist who is comfortable working with breast cancer patients. Check with your oncologist for referrals, and have a frank discussion with your oncologist about your risks may be. Certain chemo-therapies can shut down your ovaries prematurely, thusly limiting a woman’s fertility. Anti-hormonal therapy can block your ability to become pregnant while you are taking the medication or can damage a fetus if you do. For women with estrogen or progesterone receptor positive disease, we often recommend 5 or even 10 years of anti-hormonal treatment after diagnosis. If you are 30 at the time your breast cancer is diagnosed, you may not be off therapy until age 40, at which time, simply due to age, your fertility may be compromised. For women in these situations, I often recommend to my patients considering harvesting of eggs either for freezing or to create embryos as soon as surgery is complete to remove the tumor but prior to embarking on chemotherapy or anti-hormonal therapy. Another important reason to consider fertility early after your diagnosis is finances.
The cost of fertility preservation is often not covered by insurance and be prohibitive for many of the women I see in practice. There are several charity organizations that will subsidize the cost of fertility preservation, such as Fertile Hope through the Lance Armstrong Foundation, but these charities often limit their grants to patients who have not yet had a single dose of fertility impairing medications. For many of my patients, these grants were the only reason they were able to afford fertility preservation, but had they not been proactive early after their diagnosis, these grants would not have been available. Finally, what I tell every patient is that the diagnosis of breast cancer, especially at such a young age, can shatter your world. It may be difficult to decide whether you want to become a mother or become a mother again when you feel like you are just fighting for your own life let alone that of any potential children. It is overwhelming. But…take charge now. Don’t burn bridges of fear of exploring your fertility options. Hesitating now may close doors for you that you didn’t know existed. Also, I encourage women who have already undergone treatment and now find themselves in a situation where pregnancy seems difficult or impossible to explore their options too. Reproductive technologies are exploding, and what might not have been possible a few years ago might be a routine now. A consultation with a fertility expert is only gaining knowledge, not committing to treatment. Knowledge is power. Empower yourself.
I was very excited to know that my daughter is appropriately referring and encouraging her patients to seek fertility counseling. Unfortunately, this is not always the case. In 2004, Dr. Anne Partridge conducted a study by surveying women in the Young Survivors Coalition, a group consisting of women 40 and under diagnosed with breast cancer. In the study, the respondents who said that fertility was of high concern in their breast cancer treatment, less than one-third were referred to a reproductive endocrinologist, and over half of women said their fertility concerns were not adequately addressed. Despite the inadequate counseling, just over half of the women in the study said that their own personal concerns impacted their decisions about accepting recommended medical care for their breast cancer. Clearly, we need to do a better job. There are very safe ways to preserve fertility and allow a woman to have her medically necessary care for her breast cancer. Here at SIRM Las Vegas, we are here to help you with these concerns. Should you or someone you know be facing a breast cancer diagnosis, please come in for at lease a consultation. We are here to help you and your family.