Egg Freezing to Ovarian Suppression: Fertility preservation options for breast cancer survivors

According to the Globocan data, breast cancer accounted for 13.5 per cent of all cancer cases in India in 2020. It is estimated that by 2030, the incidence of breast cancer will double, and there will be over two million cases of breast cancer worldwide. Often, women suffering from breast cancer fear that their condition can lead to infertility and affect their reproductive health. However, it is important to understand that breast cancer itself doesn’t affect or lead to infertility. Instead, the treatment for this condition tends to raise concerns and might affect a woman’s reproductive health, leading to difficulty in ovulation and subsequently conceiving. In addition to this, breast cancer survivors fear that they may not be able to conceive even after getting treated. There are indeed certain challenges in such a condition; however, medical advancements and the availability of fertility preservation techniques have now made it easier for breast cancer survivors to embrace motherhood.

How does breast cancer treatment affect fertility?

According to Dr Rachita Munjal, Senior Consultant, Birla Fertility & IVF, Gurugram, breast cancer treatment, including chemotherapy, radiation therapy, and hormonal therapy, can significantly impact fertility. Chemotherapy drugs may damage ovarian function, reducing egg production and potentially causing infertility. Radiation therapy, particularly when targeted near the ovaries, can harm ovarian tissue, and decrease fertility. Hormonal therapies may disrupt ovulation and menstrual cycles, affecting fertility. However, it must be noted that this doesn’t eliminate the possibility of conception post-treatment or directly lead to infertility.

Is it possible for breast cancer survivors to conceive naturally?

Cancer survivors' ability to conceive naturally post-treatment depends on various factors, including age, treatment type, and pre-existing fertility issues. Chemotherapy, radiation, and hormonal therapies commonly affect fertility by impacting ovarian function and egg viability. Despite these challenges, many women retain natural fertility, especially younger women undergoing milder treatments. These issues are curable through timely detection and subsequent treatment. Some may experience temporary menstrual disruptions, with fertility often resuming post-treatment. However, for such individuals, techniques like egg or embryo freezing are suggested to preserve fertility for future assisted reproductive procedures.

What are the fertility preservation options for breast cancer survivors?

Breast cancer survivors can opt for the following treatment options to preserve fertility:

• Egg Freezing (Oocyte Cryopreservation): This involves ovarian stimulation to prompt the production of multiple eggs. These eggs are then retrieved, frozen, and stored for future use.
• Embryo Freezing (Embryo Cryopreservation): This helps to create embryos through in vitro fertilization (IVF) using the woman's eggs and partner's sperm, which are subsequently frozen.
• Ovarian Tissue Freezing: This entails surgically removing, freezing, and storing a portion of ovarian tissue before cancer treatment, with the potential for transplantation post-treatment to restore ovarian function.
• Ovarian Suppression: Using medications like GnRH agonists temporarily halts ovarian function to safeguard fertility during cancer treatment.

When should breast cancer survivors consider fertility preservation?

It is recommended that breast cancer survivors delay conception by 6 months after completing the treatment. Additionally, fertility preservation techniques such as oocyte and embryo cryopreservation must be carried out before chemotherapy or radiotherapy.

Are there any risks associated with fertility preservation options?

There is no doubt that fertility preservation for breast cancer survivors carries potential risks and limitations. Ovarian stimulation for egg retrieval may occasionally lead to ovarian hyperstimulation syndrome and other complications. Additionally, fertility preservation techniques may not be suitable for all individuals, depending on the cancer type and treatment plan. Therefore, survivors need to discuss risks, benefits, and limitations with their fertility experts before pursuing fertility preservation options.

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