Not being able to have children is very hard for most women
whether or not they already have children. Fertility is such an important part
of many people’s lives. Not being able to have children can seem hard when you
already have to manage Breast Cancer. Loss of fertility is
not usually something people can come to terms with in a short time. There is
often the need to allow time to adjust and express sadness that part of the
affected person’s life has been taken away.
We know that how breast cancer treatment affects
fertility depends largely on three major factors.
These are the type of treatment used: the type and stage of the cancer
at the time it was diagnosed, and finally, the age of the patient. The
good news is that not all Breast Cancer treatments affect
fertility. For instance, if a patient needs only Surgery and Radiation
and no Chemotherapy, the treatment will have no impact on future
fertility. However, Breast Cancer patients treated with Chemotherapy run the risk
of developing complications such as premature Ovarian failure or very
early menopause. On its own, breast cancer can be scary enough
for any woman to worry about, and when it becomes associated with infertility,
the worry becomes a lot more pronounced.
Nothing could be more distressing for a woman than being
afflicted with breast cancer and wondering if it will also prevent her from
having children. These days, more and more Nigerian women are diagnosed with Breast
Cancer in their childbearing years, and many want to know how the
disorder will affect their fertility. Questions like what are
risks posed by cancer treatment, the methods of preserving fertility,
and ways cancer might affect future offspring are bound to come up. Research
suggests that pregnancy does not increase the chance of breast cancer returning,
but it pays to find out the risks and the implications. Quite often, it is
advised that it is best to wait a while after treatment has finished before
trying to get pregnant. Most doctors recommend waiting two years. Not because
the pregnancy could affect the breast cancer, but because, if the woman is
going to have a recurrence, it is most likely to be within the first two years
after diagnosis.
The longer a patient stays free from breast cancer, the less
likely it is that it will come back. But she still needs to think about what
might happen if the cancer comes back after having her baby. Age plays a big
role in a cancer patient’s future fertility and this is why the age of
the woman at the start of systemic chemotherapy is usually the usually the
biggest predictor of infertility. For a 30-year-old woman, regardless of the
fertility risks associated with breast cancer treatment, methods to preserve
fertility prior to treatment offer hope to many patients. It is undeniable that
some breast cancer treatments cause infertility. This may be temporary or
permanent. We know for instance that Radiotherapy will only cause Infertility
if it is given to both ovaries. This treatment, which is known as
ovarian ablation, brings about changes within the tissues so that the ovaries
become inactive. This brings on an early menopause resulting in permanent
infertility. It may be offered if tumor is dependent on the hormone estrogen
(described as estrogen receptor positive).
So, the bottom line is that the woman will not be able to
have children if she has had radiotherapy done to her ovaries or undergone an
operation to remove her ovaries. The aim of the treatment is to reduce the risk
of the cancer coming back in the future. Temporary or permanent infertility can
be a side effect of chemotherapy in pre-menopausal women.
Essentially, chemotherapy does not damage a
woman’s egg, but it causes changes within the ovaries that stop eggs being
released. But you may want to ask if all pre-menopausal women who have
chemotherapy become infertile? The answer is straightforward. If you are having
chemotherapy, the likelihood of you becoming infertile depends on the type of
drug(s) used, the dose given and your age. Generally speaking, the younger you
are, the more likely you are to retain your fertility.
The chemotherapy drugs most likely to cause infertility are
a group called the ‘alkylating agents’, one of which is commonly used in
combination with other chemotherapy drugs to treat Breast Cancer. The effect that other drugs have on
fertility has not been extensively studied. Other drug treatments result in
potentially reversible forms of ovarian ablation, so fertility is only affected
temporarily. Periods should usually start again within six months of
stopping the treatment. The ode of drug that would cause periods to stop (amenorrhea)
varies depending on age. Women who are over 40 develop amenorrhea following
much lower doses of chemotherapy drugs than women who are under 40. It is also
possible for younger women to stop having periods temporarily during treatment
and to start their periods again later, even months after treatment has
finished. Chemotherapy or Hormone therapy are most likely to
make a woman permanently infertile if she is near to the age when her menopause
is likely to start, say around 40. But since different women go through
menopause at different ages, this can also vary. Surgery to the breast will
also not affect fertility. While it can be difficult to diagnose infertility as
a result of chemotherapy, criteria used to determine if the ovaries are working
including whether or not periods start again, hormone levels and evidence that
the ovaries are not working such as hot flushes and vaginal dryness (menopausal
symptoms). If the period doesn’t start again, the woman may still be producing
eggs and could still become pregnant. If she is sexually active and doesn’t want
to get pregnant, it is best to continue with contraception. Generally speaking,
cancer patients should assume that they could still get pregnant unless that
they have not had a period for at least a year since completing treatment. It
is important to discuss contraception with a specialist team who may then refer
you to a family planning clinic or back to your own Physician. It is
generally recommended that women who wish to avoid pregnancy use non-hormonal methods
of contraception. This is because of the possibility that the hormones in the
contraceptive pill could stimulate any remaining breast cancer cells.
About 40-80 percent of women treated with an often
prescribed drug called Cyclophoshamide are known to develop
ovarian failure afterwards. How advanced a Cancer is upon detection, as well as
what type it is, also dictates whether chemotherapy will be required, thereby
affecting the risk of side effects to the ovaries. The more advanced the cancer
upon detection, the greater likelihood that chemotherapy, which affects the
whole body, will be used to treat it. For instance, invasive breast
cancer typically requires systemic chemotherapy, whereas a
small tumor with small nodes that is localized and contains a minimal threat of
spreading may not. The type of tumor also impacts a patient’s treatment
options.
Some breast cancers can be treated with the use of hormone-containing
drugs. But we know that a small percentage of breast cancer tumors cannot be
treated with hormones. For this type of tumors, chemotherapy is the only option. Indeed, there does
not seem to be any increased risk of birth defects if the woman who has gone
through breast cancer treatment gets pregnant.
Generally, news of a breast cancer diagnosis as well as
focusing on how it might affect future fertility can be overwhelming. But
because there are people trained to provide the best cancer treatment available
and not necessarily in light of fertility options seeking information on
fertility need to remain proactive. If you are still fertile, there doesn’t
appear to be any extra risk of breast cancer coming back if you
then get pregnant.
As a general guide, many specialists advise women to wait
for at least two years after a diagnosis of breast cancer as this is
considered to be the most common time for a cancer to recur. Waiting for this long may not be appropriate for
every woman.
If you are thinking about getting pregnant, it is important
to talk to your Specialist team who will help you to make a decision based on
your individual circumstances and wishes.
Preserving fertility is something you would need to talk
over with your specialist team. A number of techniques are possible, although
some of these are only in the very early stages of research and are not widely
available. Freezing embryos is one procedure. It involves taking hormone
drugs to stimulate the ovaries
to produce enough eggs so that they can be fertilized and stored. Although no
one knows what effects these hormones may have, there is a possible risk that
they could stimulate the growth of any remaining breast cancer cells. The
procedure would also delay chemotherapy by about a month. Hormone drugs are given
over a 28-day cycle to make the ovaries produce several eggs. The eggs are
removed in a small operation and are then fertilized with the partner or
donor’s sperm.
These fertilized embryos can be then be frozen and stored
for up to ten years so that you can start or extend your family later. This
technique does not guarantee that you will get pregnant however.
Another possible way of preserving fertility is to remove
and freeze a small section of ovarian tissue before chemotherapy. At a later date, it may be possible
either for the eggs to be matured in the laboratory or the tissue reimplanted.
This technique is in the very early stages of research and is not widely
available. It may be possible to get pregnant by receiving eggs donated by
other fertile women.
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