Review
. 2013 Dec; 173:13-8.
doi: 10.1016/j.ejogrb.2013.11.009.

Fertility after breast cancer treatment

Miro Kasum 1 Lidija Beketić-Orešković 2 Parvin F Peddi 3 Slavko Orešković 4 Rebecca H Johnson 5 
Affiliations
  • PMID: 24315568
  •     12 citations

Abstract

In many countries of the developed world, there is an increasing trend toward delay in childbearing from 30 to 40 years of age for various reasons. This is unfortunately concordant with an increasing incidence of breast cancer in women who have not yet completed their family. The current choice for premenopausal women with breast cancer is adjuvant therapy which includes cytotoxic chemotherapy, ovarian ablation (by surgery, irradiation, or chemical ovarian suppression), anti-estrogen therapy, or any combination of these. Although the use of adjuvant therapies with cytotoxic drugs can significantly reduce mortality, it raises issues of the long-term toxicity, such as induction of an early menopause and fertility impairment. The risk of infertility is a potential hardship to be faced by the patients following treatment of breast cancer. The offspring of patients who became pregnant after completion of chemotherapy have shown no adverse effects and congenital anomalies from the treatment, but sometimes high rates of abortion (29%) and premature deliveries with low birth weight (40%) have been demonstrated. Therefore, the issue of recent cytotoxic treatment remains controversial and further research is required to define a "safety period" between cessation of treatment and pregnancy. Preservation of fertility in breast cancer survivors of reproductive age has become an important issue regarding the quality of life. Currently, there are several potential options, including all available assisted technologies, such as in vitro fertilization and embryo transfer, in vitro maturation, oocyte and embryo cryopreservation, and cryopreservation of ovarian tissue. Because increased estrogen levels are thought to be potentially risky in breast cancer patients, recently developed ovarian stimulation protocols with the aromatase inhibitor letrozole and tamoxifen appear to provide safe stimulation with endogenous estrogen. Embryo cryopreservation seems to be the most established fertility preservation strategy, providing a 25-35% chance of pregnancy. In addition, oocyte freezing can be considered as an alternative in patients who are single and in those who do not wish a sperm donor. Although ovarian tissue harvesting appears to be safe, experience regarding ovarian transplantation is still limited due to low utilization, so the true value of this procedure remains to be determined. Nevertheless, in clinical situations in which chemotherapy needs to be started in young patients facing premature ovarian failure, ovarian tissue preservation seems to be a promising option for restoring fertility, especially in conjunction with other options like immature oocyte retrieval, in vitro maturation of oocytes, oocyte vitrification, or embryo cryopreservation. It seems that in vitro maturation is a useful strategy because it improves oocyte or cryopreservation outcome in breast cancer patients undergoing ovarian stimulation for fertility preservation.

Keywords: Breast cancer; Fertility; Pregnancy; Treatment.

Occurrence and recall rates of fertility discussions with young breast cancer patients.
Rahul Banerjee, Ekaterini Tsiapali.
Support Care Cancer, 2015 May 15; 24(1). PMID: 25967235
The impact of chemotherapy for breast cancer on sexual function and health-related quality of life.
Juliane Farthmann, A Hanjalic-Beck, +5 authors, A Hasenburg.
Support Care Cancer, 2016 Jan 06; 24(6). PMID: 26728760
Fertility Preservation for the Young Breast Cancer Patient.
Shari B Goldfarb, Sabrina A Kamer, +6 authors, Mary L Gemignani.
Ann Surg Oncol, 2016 Jan 23; 23(5). PMID: 26790670    Free PMC article.
Reasons Why Young Women Accept or Decline Fertility Preservation After Cancer Diagnosis.
Patricia E Hershberger, Heather Sipsma, Lorna Finnegan, Jennifer Hirshfeld-Cytron.
J Obstet Gynecol Neonatal Nurs, 2016 Jan 28; 45(1). PMID: 26815806    Free PMC article.
Premature ovarian insufficiency: the context of long-term effects.
A Podfigurna-Stopa, A Czyzyk, +4 authors, B Meczekalski.
J Endocrinol Invest, 2016 Apr 20; 39(9). PMID: 27091671    Free PMC article.
Review.
Ovarian Follicle Depletion Induced by Chemotherapy and the Investigational Stages of Potential Fertility-Protective Treatments-A Review.
Xia Hao, Amandine Anastácio, Kui Liu, Kenny A Rodriguez-Wallberg.
Int J Mol Sci, 2019 Sep 25; 20(19). PMID: 31548505    Free PMC article.
Review.
Fertility preservation before neoadjuvant chemotherapy in a premenopausal breast cancer patient: a case report.
Arika Kobayashi, Ryoichi Matsunuma, +3 authors, Kazuhiko Nakagami.
Oxf Med Case Reports, 2019 Dec 18; 2019(11). PMID: 31844530    Free PMC article.
Breast cancer: an update on treatment-related infertility.
Erica Silvestris, Miriam Dellino, +3 authors, Stella D'Oronzo.
J Cancer Res Clin Oncol, 2020 Feb 02; 146(3). PMID: 32006118
Review.
Full-term pregnancy in breast cancer survivor with fertility preservation: A case report and review of literature.
Marta Garrido-Marín, Pedro Maria Argacha, +4 authors, Pepita Gimenez-Bonafé.
World J Clin Cases, 2019 Jan 15; 7(1). PMID: 30637253    Free PMC article.
FERTILITY PRESERVATION IN YOUNG WOMEN WITH EARLY-STAGE BREAST CANCER.
Petra Vuković, Miro Kasum, +5 authors, Ermin Čehić.
Acta Clin Croat, 2019 Aug 01; 58(1). PMID: 31363337    Free PMC article.
Review.
Current Understanding of the Etiology, Symptomatology, and Treatment Options in Premature Ovarian Insufficiency (POI).
Bunpei Ishizuka.
Front Endocrinol (Lausanne), 2021 Mar 16; 12. PMID: 33716979    Free PMC article.
Review.
Adolescent use of hair dyes, straighteners and perms in relation to breast cancer risk.
Alexandra J White, Allyson M Gregoire, +5 authors, Dale P Sandler.
Int J Cancer, 2020 Dec 01; 148(9). PMID: 33252833    Free PMC article.