Can my sister's fertility be preserved after starting chemo?

Question

Hello doctor,

My elder sister has been diagnosed with breast cancer, and she is only 39 years old. Along with undergoing treatment, she is very anxious about how this will affect her future as a woman. She has not had children yet and was planning to start a family soon. Now we are confused about whether chemotherapy or radiation will impact her fertility. We want to ask:

Is it possible for her to preserve her eggs before treatment, or is it too late since she has already had two chemotherapy sessions?
She is also worried about hormonal changes after a mastectomy and whether that could trigger early menopause. Can women with breast cancer use in vitro fertilization (IVF) later safely?
How risky would pregnancy be after recovery?
Should she consider surrogacy?
Also, are birth control pills safe for women with her condition?

Please help.

Thank you

Answer 1

Hello,

Welcome to icliniq.com.

I feel very sorry to hear about your sister. I completely understand her concerns, and these are very important questions to address early during treatment.

Chemotherapy drugs commonly used in breast cancer can reduce ovarian reserve (the number and quality of eggs in the ovaries) and, in some cases, induce early menopause (the permanent stopping of menstrual cycles before the usual age). Radiation therapy directed to the pelvis directly affects fertility, but in breast cancer treatment, the radiation is usually not targeted at the ovaries, so the risk is lower.

Ovarian function can still decline faster after chemotherapy, which may lead to early menopause in some women. Symptoms may include hot flashes, irregular menstrual cycles, or cessation of periods.

Fertility preservation and family planning should be individualized depending on her cancer type, stage, and treatment plan. Egg or embryo freezing may still be possible, but the success depends on how much chemotherapy has already been received and how her ovaries are functioning now. Psychological counseling and fertility counseling can provide support and help her make informed decisions.

Regular and consistent follow-up with her oncologist (cancer specialist) and gynecologist (women’s health doctor) is very important. Monitoring ovarian function after treatment will help in planning family-building options, such as in vitro fertilization (IVF).

Many women can safely undergo IVF (in vitro fertilization, where eggs are fertilized outside the body and placed in the uterus) after recovery, depending on their cancer type and hormone-receptor status. The safety of pregnancy after breast cancer depends on the individual case.

In some women, pregnancy is considered safe after a period of remission, while in others, especially if the cancer is hormone-sensitive, additional precautions are needed. Surrogacy may be considered if pregnancy is medically unsafe or not possible after treatment.

Hormonal contraceptives such as birth control pills are generally not recommended for women with breast cancer, especially if the cancer is hormone-receptor positive (cancer cells grow in response to hormones like estrogen or progesterone). Safer choices include non-hormonal methods, such as barrier methods (condoms, diaphragm) or a copper intrauterine device (IUD).

 I hope this helps.

Kindly revert if there are any queries.

Thank you.