Pregnancy, fertility and menopause

Your oncologist’s (breast cancer specialist) main aim is to treat your breast cancer while causing the fewest possible side effects. However some of the treatments you may be offered can have an impact on your fertility.

Some chemotherapy and hormone therapies used in the treatment of breast cancer can bring about an early menopause and cause temporary or permanent infertility (being unable to get pregnant).

If preserving your fertility is a concern for you, talk to your specialist team before your treatment begins and ask for a referral to a fertility clinic.

Fertility treatments can be time-consuming and take up a lot of emotional and physical energy. It can be difficult dealing with these issues at the same time of the diagnosis of breast cancer. Your oncologist or breast care nurse will talk with you about your individual treatment options, and how your fertility might be affected.

Kate Hinds was diagnosed with breast cancer at the age of 43.

Possible ways to preserve fertility before treatment begins

Younger women with breast cancer are generally offered chemotherapy. It is difficult to predict exactly how your fertility will be affected by this treatment. Chemotherapy can affect the function of the ovaries resulting in less or no eggs being produced, which can lead to infertility. Most women’s periods will stop or become irregular during chemotherapy and whether they return will depend upon the type of drugs used, the dose given and your age.

The risk of permanent infertility is greatest if you are over 35 years of age. However, even if the periods return, the menopause may occur earlier than it would have done naturally.

If your main concern is to preserve your fertility, you may consider declining chemotherapy. You should think carefully about this and discuss it with your specialist team. There may be a particular type of chemotherapy that appears to be less harmful to the ovaries. In some circumstances it may be possible for women to have monthly injections of goserelin (Zoladex) as an alternative to chemotherapy or tamoxifen. Your specialist team can advise you if this is an option.

There are several reproductive procedures that may have limited availability and success. Not all are available on the NHS. Talk to your specialist fertility unit who will be able to advise you further.

IVF (in vitro fertilisation)

This procedure involves taking hormone drugs to stimulate the ovaries. This aims to produce enough eggs so that they can be harvested, fertilised (with sperm from a partner or donor) and stored as embryos. It is not fully known what effects these hormones may have. There is a possible risk that they could stimulate the growth of breast cancer cells and this can delay chemotherapy for up to two months.

Fertilised embryos can be frozen and stored for up to 10 years before being implanted in the womb. IVF does not guarantee that you will get pregnant.

Freezing eggs

This procedure is similar to IVF in that ovaries are stimulated to produce eggs that are then frozen. They can be thawed and fertilised (with sperm from a partner or donor) when you want to get pregnant later in life. However, this is a delicate procedure and eggs are easily damaged in the freezing and thawing process.

Freezing ovarian tissue

This technique is in the early stages of research and as yet there have been no recorded live human births from it in women with breast cancer. A small section of ovarian tissue is removed and frozen. The ovarian tissue can be put back into the body at a later date.

IVM (in vitro maturation)

This is a new technique and is currently not widely available. It involves removing immature eggs from ovaries that have not been stimulated by the use of hormone drugs. These are then matured in the laboratory before being fertilised and then being frozen. The embryos are then transferred to the womb at a later date. The number of babies born worldwide using this method is very few.

Possible ways to preserve fertility during treatment

It is thought that using a hormone drug treatment called goserelin (Zoladex) alongside chemotherapy may protect the ovaries so that the chemotherapy is less likely to damage them. Clinical trials are currently being carried out to establish the effectiveness of this treatment. Periods usually start again within six months of stopping goserelin treatment.

If you have been offered tamoxifen treatment, this is usually given for five years by which time you may be facing a natural menopause. If the length of tamoxifen treatment concerns you, talk to your specialist team who will be able to advise you further.

Fertility following breast cancer treatment

Options for preserving fertility following treatment are limited as damage to the ovaries may already have occurred. Periods can return up to 12–18 months after chemotherapy.

Generally speaking, if you are 40 or over you should assume that you can still get pregnant unless you haven’t had a period for at least a year. If you are under the age of 40 you should assume that you can still get pregnant unless you haven’t had a period for two years after completing your treatment. For those women whose periods return, it may be possible to have pregnancies after breast cancer treatment.

There are several ways of checking a woman’s future fertility after treatment by using blood tests and/or ultrasound scans. The blood tests measure the level of follicle stimulating hormone (FSH), and in some cases Anti Mullerian Hormone (AMH). However, the accuracy of these tests may be affected if you are taking hormone therapy for breast cancer.

It may also be possible to get pregnant by using donated eggs. There is a shortage of egg donors so there can be a long wait for treatment. This procedure involves taking hormone replacement therapy (not fertility drugs) to prepare the womb, which may not be suitable for all women.

There is no evidence that cancer treatments can harm children that you have after treatment. Generally you will be advised to wait two years after your diagnosis before becoming pregnant. This is because the possibility of the cancer coming back can lessen over time so that the first two years after diagnosis is when you may be at greatest risk.

Contraception during treatment

It is advisable to avoid getting pregnant during your treatment with chemotherapy, radiotherapy and hormone treatment. This is because these treatments can damage your eggs, and could possibly harm a baby conceived at this time.

Even if your periods haven’t started again, you may still be producing eggs and could still become pregnant. The oral contraceptive pill is less commonly advised for woman following a diagnosis of breast cancer. This is because the hormones in the contraceptive pill could stimulate any remaining breast cancer cells to grow.

This will mean using a barrier method such as condoms, Femidoms or diaphragm. It may also be possible to use a coil (IUD) although this is something you would need to discuss with your specialist as not all types are suitable for women who have had breast cancer.

Most breast cancer specialists say that the morning after pill is acceptable in an emergency, although there is no research to support this.

Early menopause

Being young and experiencing an early menopause, due to treatment for breast cancer, can result in menopausal symptoms which can be more intense than if you were going through the menopause naturally.

For more information about the menopause and help with relieving the symptoms, please download or order our factsheet on Menopausal symptoms and breast cancer and our Complementary therapies booklet.