One out of twenty breast cancers occur in women under the age of 40 and at least half of these women still desire to protect future fertility. Yet less than 10 percent of women have a child after diagnosis and treatment for breast cancer. The cytotoxic chemotherapy utilized to treat the cancer creates the biggest issues, resulting in a low birth rate and decreased fertility. This chemotherapy usually causes significant oocyte depletion and reproductive aging equivalent to 10 years.  Because many regimens also include taking tamoxifen for five years after chemotherapy, a woman’s ovarian reserve will be too low to conceive once treatment finishes. For this reason, oocyte or embryo cryopreservation prior to chemotherapy is becoming more common.

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Studies have shown that pregnancy following breast cancer treatment does not increase the risk of recurrence. The focus then becomes whether or not harvesting oocytes prior to chemotherapy increases the recurrence rates. Answering the question is complicated because not all breast cancers develop in the same manner; some are hormone receptor positive, others are genetically controlled and some are node positive or negative. 

Are any of these groups more or less likely see an impact from ovulation induction and oocyte retrieval prior to chemotherapy? Unfortunately, no definite answer has been reached.  Protocols exist that allow for the retrieval of multiple oocytes without creating elevated estrogen levels in the receptor positive women. With shorter protocols, which can be completed in a two to three week time frame, chemotherapy initiation is minimally delayed.  In women without a partner, oocyte cryopreservation is now an option thanks to the process of vitrification, or rapid freezing.

Breast cancer survival rates are continuing to improve, so addressing the fertility desires of these women is becoming more important. By working together, reproductive endocrinologists and oncologists can provide successful outcomes for their patients that will protect their health and fertility.