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How Breast Cancer Can Affect Fertility

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According to the American Cancer Society, there will be 232,670 new cases of invasive breast cancer diagnosed in 2014. Of those diagnoses, the majority will be in women over 50 years of age who have passed their childbearing years.

But for fewer than 5 percent of those new cases, women will be age 40 or under.

That adds up to roughly 11,000 women. Or if you are looking at statistical probabilities, 1 in 227 women age 30 and 1 in 68 women age 40. Breast cancer diagnoses are higher in African-American women and women of Ashkenazi Jewish descent.

Overall, it's a small number. Not a big deal, right? Wrong.

Because young cancer patients comprise such a small portion of the breast cancer population, the younger breast cancer population can, at times, not receive the attention they deserve.

Studies may focus more on the upward swinging age ranges and disregard the younger populations. Well-meaning oncologists, determined to remove cancer as quickly as possible, may neglect to have the crucial patient conversation about future family building plans.

A cancer diagnosis is devastating and will turn your world upside-down. Winning the breast cancer battle only to find you are unable to conceive or carry a child opens the pages to an entirely new book of pain.

And this pain can be avoided.

I'd like to walk you through some of the basics that can help you (or someone you know) move forward as an informed and educated patient (or advocate).

A breast cancer diagnosis does not mean you will be infertile.

The degree to which breast cancer affects fertility is dependent upon a variety of factors such as the type of breast cancer you are diagnosed with, the progression of the cancer, whether you will enter early menopause and the cancer treatment prescribed. A discussion between your oncologist and reproductive endocrinologist can better estimate what your fertility potential will be after cancer treatment.

Fertility drugs are not linked with cancer.

A recent study has confirmed that there is no link between breast cancer risk and fertility treatments. But increases in hormones can accelerate certain types of breast cancer. While a woman is pregnant or on fertility drugs, her hormone levels are increased. If a hormone-sensitive tumor is present in the breast, there is a possibility that breast cancer growth will accelerate.

Cancer treatment can harm fertility potential.

When taking into consideration how cancer treatment will affect fertility, there are a number of different factors. Cancer type and age play a large role -- some cancers are more aggressive than others and may be hormone-sensitive. As women, we are born with as many eggs as we will have in our lifetime. The resilience and health of eggs for a women 39 years of age will not be the same when compared to a woman five years younger.

Treatment prescribed, be it surgery, chemotherapy or radiation, will determine how much damage the ovaries and reproductive organs will sustain. Delving further, the dose, type, duration, location and scope used for these methods will also affect whether or not treatment will impact fertility.

There are various techniques oncologists can use that can minimize the damage done to reproductive potential. Ovarian shielding can protect ovaries during radiation while ovarian suppression methods temporarily shut down ovaries. In ovarian transposition, ovaries are moved higher in the abdomen and away from the radiation field through surgical methods.

After treatment, some women may retain their fertility potential. For others, menopause may arrive earlier in life, or even immediately after treatment. Taking into account all of these factors can make it very difficult to predict whether a women's eggs or reproductive organs will maintain function.

It is best to have a very open and honest discussion with your oncologist as well as consult a reproductive endocrinologist. With both teams working on your behalf, your probability for future success is increased.

Fertility can be preserved in women.

If you are planning on having a family after breast cancer treatment, there are several different options to preserve or protect your fertility.

Egg Freezing

Egg freezing can be roughly a 1-2 month process. However, with cancer patients the evaluation and treatment are done together to quickly freeze eggs and move on to cancer treatment immediately. First, patients must complete blood tests and ultrasounds to determine candidacy for egg freezing. Next, two weeks of medicine are taken to prepare the eggs and then an egg retrieval procedure is done. While you are on medicine, the growth of the eggs is monitored with ultrasound and blood tests to see when they will be ready. During the egg retrieval, you will be placed under light sedation and may feel a bit of cramping and bloating afterwards. The goal is to freeze somewhere around 10-15 eggs to optimize the chance of success later. Patients with hormone-sensitive breast cancer or breast cancer that has progressed may not be eligible for this form of fertility preservation.

Embryo Freezing

Should you already have a partner, this is the best option for future success. As you can imagine, eggs are extremely delicate and fragile and not all frozen eggs will survive the thawing process. You will need to undergo an egg retrieval after which your eggs will be fertilized with your partner's sperm. The resulting embryos are frozen and can be used in the future for treatment. If carrying a baby in the future is not a possibility, a gestational carrier or surrogate is also an option.

Ovarian Tissue Freezing

While this is still an experimental procedure that is not widely available, ovarian tissue freezing is an exciting option for those looking to preserve fertility. Patients undergo a surgical procedure where part or all of an ovary is removed. The ovarian tissue containing immature eggs and hormone-producing cells is then cut into strips and cryopreserved. After a patient is cancer-free, the frozen ovarian tissue is thawed and transplanted back to the patient's uterus. Even if this isn't for three years, the frozen ovarian tissue will remain the same age as when it was cryopreserved.

If you have cancer and want to pursue fertility preservation, the first step is to talk to your oncologist as to whether it is medically appropriate. Next, make an appointment with a fertility specialist and ask your oncologist for a letter of medical clearance stating it is permissible to consider this option as well as the time-frame that you can pause cancer treatment (ideally 2-4 weeks or longer).

There are programs that can curb the cost of fertility preservation.

Most fertility centers offer fertility preservation discount programs for cancer patients seeking to freeze eggs or embryos. At our center we decrease costs and get patients more affordable medication. We also work closely with two programs that offer free medication -- the Ferring Heartbeat Program and the EMD Serono LIVESTRONG Fertility Program. LIVESTRONG also offers a fertility discount program.

This too shall pass.

On your next doctor visit, this information can arm you with the knowledge and know-how to navigate difficult conversations and make the choice that is best for you.

Many young women who have been faced with this difficult diagnosis are afraid of the treatment and want to be cured. But the second most common question is, "Can I have a baby later?" The current treatments of cancer can be very effective and many patients go on to lead healthy lives. Therefore this added treatment of fertility preservation can add the dream of a family to their lives.

For those of you challenged with a breast cancer diagnosis, I will leave you with an inspiring quote from someone who has been in your shoes.

"I'm stronger than I thought I was. My favorite phrase has been 'This too shall pass.' I now understand it really well." -- Robin Roberts