Can I conceive after my breast cancer treatment at 39?

Question

Hello doctor,

I am 39 and was diagnosed with stage 3 breast cancer five months ago, and the treatment is destroying my body. I had a bilateral mastectomy with reconstruction, then started chemotherapy with the dose-dense AC-T protocol.

The tumor was 1.6 inches, grade 3, ER positive 85 percent, PR positive 70 percent, HER2 negative, with four out of eight lymph nodes positive. Finished four cycles of Doxorubicin and Cyclophosphamide, which caused terrible nausea, mouth sores, and complete hair loss.

Now, I am on Paclitaxel weekly, and the neuropathy in my hands and feet is so bad that I drop things constantly. My periods stopped after the second chemotherapy, and I am having horrible hot flashes, night sweats, and vaginal dryness. The oncologist says I am in chemotherapy-induced menopause at 39, which is devastating.

My tumor markers, CA 15-3 and CEA, are coming down, which is good, but the side effects are unbearable. Developed neutropenia with ANC dropping to 600, requiring Neupogen injections.

After chemotherapy, I will need radiation, then five to 10 years of Tamoxifen, which means no pregnancy during my remaining fertile years. Froze embryos before chemotherapy, but the process was rushed, and I only got four. The breast cancer diagnosis has caused severe anxiety and depression. Can I ever get pregnant after breast cancer treatment? Should I do ovarian suppression during Tamoxifen or try to preserve some fertility?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am really sorry to hear that you were diagnosed with breast cancer. I completely understand your fear and worry, especially since you are still in your thirties and thinking about having children.

It was a good decision you freeze the embryo; that was really smart. I want to reassure you that we can still protect your fertility while giving you hormonal therapy.

We have a strategy called “fertility preservation,” where we can give you Tamoxifen together with another medicine called Goserelin (Leuprolide). This medicine helps protect your ovaries so that they can work normally again after finishing hormonal therapy.

Also, during hormonal therapy, after you have finished chemotherapy for at least two years, we can take a short break from the hormonal treatment if you want to get pregnant. After pregnancy and breastfeeding, we can restart the hormonal therapy.

So now, many new strategies allow us to protect your fertility and give you the best chance to have children in the future. I do not want you to lose hope at all.

About the side effects you are experiencing now- like the hot flashes, dryness, and the absence of your period; I want to reassure you that after finishing chemotherapy, these usually start to improve within about three months. Your period can return, and your body functions often go back to normal. The hot flashes and other symptoms usually fade gradually.

During this time, you can take medicines and supplements to help you feel better, like Gabapentin for hot flashes and nerve pain, multivitamins, omega-3, and vitamin B complex to support nerve recovery and reduce neuropathy.

Regarding the neutropenia (low white blood cell count), this is common with chemotherapy, and it usually improves once the chemotherapy cycles are finished. Your bone marrow and blood function will recover naturally. During this period, make sure you eat well, stay hydrated, and include healthy fruits and good nutrition in your diet.

About your anxiety and stress, I really recommend joining a support group, especially one for young women with breast cancer. There are many online therapy and support groups that provide psychological and emotional help. If your anxiety feels overwhelming, please do not hesitate to seek professional support.

But I want to assure you that none of this is hopeless; every problem has a solution. As for fertility, as I mentioned before, we have ways to manage and protect it. Just make sure to talk to your medical team about your fertility wishes, so they can guide you properly.

Treatment plan: Hormonal therapy, fertility-preserving strategies.
Regarding follow-up: After seven days.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.