Effects on fertility

Some breast cancer treatments can affect your ability to have children (fertility). This can be a major concern for many younger women, because having a family can be an important part of moving on with life after cancer. Some women, particularly younger women, have no difficulties getting pregnant naturally after treatment.

After treatment, doctors usually advise that you wait for at least two years before getting pregnant. This is the time when the cancer is most likely to come back, but it also gives you time to recover from treatment. Your specialist can advise you on the risk of the cancer coming back and how safe pregnancy is in your situation.

Infertility may be temporary or permanent, depending on the treatment you’ve had and your age. Some women need to continue using contraceptives to prevent pregnancy. Check with your breast care nurse or cancer specialist to find out if you need to. Women who have had breast cancer are advised not to take the contraceptives containing hormones, because these could encourage breast cancer cells to grow. Your cancer specialist or specialist nurse will give you more advice about this.

Effects on fertility

Some breast cancer treatments can affect your ability to have children (fertility). For many younger women, this can be a major concern. Having a family can be an important part of moving on with life after cancer. Some women, particularly if they’re younger, have no difficulties getting pregnant naturally after treatment.

Doctors usually advise that you wait at least two years after treatment before getting pregnant. This is the time when the cancer is most likely to come back, but it also gives you time to recover from treatment.

Pregnancy raises your natural hormone levels so it’s important to talk to your specialist first if you are planning to get pregnant. However, recent research has shown that pregnancy after breast cancer does not increase the risk of your breast cancer coming back, even if the original cancer had hormone receptors (oestrogen positive). Your specialist can advise you on the risk of the cancer coming back and how safe pregnancy is in your situation.

You should avoid getting pregnant while taking tamoxifen as this increases the chances of a multiple pregnancy, such as twins or triplets.

Infertility may be temporary or permanent, depending on the treatment you’ve had and your age. The older you are, and the closer you are to your natural menopause, the higher the risk of infertility.

Check with your breast care nurse or cancer specialist if you’re not sure if you need to continue using contraceptives to prevent pregnancy. Women who have had breast cancer are advised not to take the contraceptive pill or use coils (IUDs) containing hormones as these could encourage breast cancer cells to grow. Your cancer specialist or specialist nurse will give you more advice about this.


How treatments may affect fertility

Hormonal therapy

Women taking tamoxifen often find that their periods change. Your periods may stop, become less regular, heavier or lighter. If your periods stop, they usually start again when you stop taking tamoxifen. Even if your periods stop, it’s still possible to become pregnant. Tamoxifen can affect an unborn baby, so it isn’t safe to become pregnant while taking it.

Tamoxifen is usually prescribed for five years. Depending on your age, this may be an issue if you want to get pregnant. It’s important to talk this over with your specialist.

Drugs, such as goserelin, which are used to stop the ovaries from working (known as ovarian suppression) cause temporary infertility. Your periods usually start again about six months after the treatment stops.

The side effects of hormonal therapy are similar to the effects of menopause. Women in their 40s may go through their menopause without knowing it, while taking hormonal therapy.


Chemotherapy

Some, but not all, chemotherapy drugs may temporarily or permanently stop your ovaries producing eggs.

Some women may go into the menopause immediately after treatment, especially if they’re close to their natural menopause.

If your periods don’t come back after some months, your specialist can do blood tests. These may help to indicate if you’ve gone through the menopause.

If you’re in your 30s (particularly if you’re under 35) and your periods stop, they will usually come back. It may take a few months or up to two years. Some young women don’t stop having periods at all. The younger you are, the more likely it is that your fertility will be preserved after chemotherapy.

Chemotherapy reduces your egg supply. This means that even if you are having periods after treatment, your menopause may start earlier than it would have without cancer treatment. It’s important to consider this if you are thinking of having a family.

Referral to a fertility clinic

If you’ve had chemotherapy and are having difficulty getting pregnant, ask your doctor to refer you to a fertility specialist. Women who have had chemotherapy are usually referred after six months of trying to get pregnant because of their risk of early menopause. The fertility specialist will give you advice on the possible options available to you.

There are different ways of becoming a parent. Some women may consider egg donation, surrogacy or adoption.

Women who had eggs or an embryo (a fertilised egg) frozen and stored before treatment can have fertility treatment later on. This may result in a successful pregnancy.

Becoming infertile can be very hard for some women to live with – whether or not they already have children. Some women may find it helpful to talk through their feelings with a trained counsellor. If you need more specialised help, your doctor can arrange this for you.