If you're planning to become pregnant after breast cancer treatment, your specialist team will discuss your fertility with you.
After your treatment has finished, there’s no totally reliable way of checking how it has affected your fertility.
To check if your ovaries are working, your specialist will ask about your periods, whether they’ve started again and whether you have any menopausal symptoms.
A series of blood tests to check the levels of a hormone called FSH (follicle stimulating hormone) can be taken. The results of these can show whether you have gone through the menopause.
Sometimes a blood test will also be taken to check the level of a hormone called AMH (anti-mullerian hormone) as this may give more accurate information about how your ovaries are working.
An ultrasound scan of the ovaries may also be helpful and is offered in some fertility centres.
You may not be able to find out straightaway after your treatment has finished if you’re still fertile. For example, you may have to wait three to six months after your chemotherapy before your blood FSH levels can be tested.
If you’re taking tamoxifen, it may be possible to test FSH levels. However, your specialist team may recommend that you stop taking tamoxifen for a few weeks before checking blood levels as there are concerns that the tamoxifen could make the test results less reliable.
Even when fertility returns after chemotherapy, the menopause is likely to occur earlier than would usually be expected. Women who have had chemotherapy are often referred to a fertility clinic after six months of trying to get pregnant because of the chance of early menopause.
Some women trying to become pregnant use ovulation prediction kits sold in chemists to find out when they’re ovulating. If you’re having periods this can be a quick way to check if and when you’re ovulating.
For many women, deciding whether to try to get pregnant after a diagnosis of breast cancer is difficult.
If you’re able to become pregnant and have a baby after your breast cancer treatment, there’s no evidence that you’re at increased risk of the cancer returning. There’s also no evidence that there are any health risks for children born after breast cancer treatment.
Do I need to wait before trying for a baby?
Many specialists advise women to wait for at least two years before becoming pregnant. This is because the possibility of the cancer coming back can lessen over time, and you may be at greatest risk in the first two years after diagnosis.
Waiting for this long may not be appropriate for everyone. If you’re thinking about getting pregnant before this two-year period is up, talk to your specialist. They can help you make an informed choice. You may want to discuss your own individual risk of recurrence as well as other relevant factors, including your age and what treatment you’ve already had and any that’s ongoing.
If you’re offered hormone therapy, it’s usually taken for five to ten years, by which time you may be facing a natural menopause. Therefore, some women choose to take a break from hormone treatment if they want to try to get pregnant. A trial called the POSITIVE trial (Pregnancy Outcome and Safety of Interrupting Therapy for Women With Endocrine Responsive Breast Cancer) is looking into the safety of interrupting hormone treatment to try to get pregnant.
Some women start taking hormone treatment again after the birth of their baby. If the length of hormone treatment concerns you, talk to your specialist team who will be able to advise you further. If you’re planning to get pregnant after you’ve finished taking the hormone therapy, it’s advisable to wait at least two months to allow time for the drug to leave the body completely.
Generally women are not recommended to get pregnant for at least four to six months after chemotherapy treatment.
The targeted therapy trastuzumab (Herceptin) is normally given for a year and is not thought to affect fertility. However, you should avoid becoming pregnant while taking trastuzumab and for at least six months after treatment has finished. This is because of the possibility of harm to a developing baby.
If your ovaries have been damaged by treatment for breast cancer, it may be possible to become pregnant using eggs donated by other fertile women. They are fertilised with sperm from a partner or donor and the embryo(s) transferred to the womb of the person hoping to become pregnant. There’s a shortage of egg donors in the UK so there may be a long wait for treatment.
The procedure involves taking some hormone drugs for around two weeks to prepare the womb to receive the embryo(s). The drugs are usually continued for up to 12 weeks if a pregnancy occurs. It’s not known what effects taking these hormone drugs might have. There’s a concern that they might stimulate the growth of breast cancer cells, although no research has proven an increased risk of breast cancer after this procedure.
Find out more information about egg donation on the HFEA website.
Some women who’ve had breast cancer treatment will face the possibility of permanent infertility. This can be devastating and difficult to come to terms with, especially if it comes at a time when you were planning to start a family or before you have completed your family. It may change how you feel about yourself as a woman and you may feel intense grief at the loss your cancer has caused.
If this is the case for you, you may find it helpful to talk to a specialist infertility counsellor. Your breast care nurse or oncologist may be able to arrange this for you.
You might also find it useful to talk to a specialist organisation, who may offer emotional support as well as information on other options such as surrogacy, adoption or fostering. For example you could try:
- British Infertility Counselling Association
- Fertility Network UK
- The Daisy Network (for women facing early menopause).
Surrogacy involves another woman carrying a baby for you. This can be an option for women who don’t want to take a break from their hormone treatment to become pregnant because they have a higher risk of breast cancer recurrence. The HFEA website has information about surrogacy.
Adoption and fostering
Some women choose to adopt or foster a child. There are many children waiting to be adopted or fostered in the UK and from abroad, and this may be an option for some people. However, adoption and fostering can be a difficult and lengthy process.
Some women choose not to have fertility treatment, surrogacy or to adopt a child and go on to enjoy life without being a parent.
Whatever your feelings, you don’t have to cope on your own. Involving your partner, family and friends can be helpful. Your specialist team and breast care nurse are there to provide information and support for you. Finding support can help you take control and help you manage some of the emotional challenges.
You may find it helpful to share your feelings with another woman whose fertility has been affected by breast cancer treatment. Breast Cancer Care’s Someone Like Me service can put you in touch with someone who has had a similar experience.
Younger Women Together provides support and information for women under 45 who have been diagnosed with primary breast cancer in the past three years.
There is a private Facebook group set up by younger women diagnosed with breast cancer called Younger Breast Cancer Network (YBCN). Many of their members have had to make decisions about fertility preservation. To access the private group you will need to have a Facebook account and send a private message to the group.
You can also seek professional support and counselling by speaking to a fertility counsellor, psychologist or your GP.
You can also download or order our booklet, Fertility and breast cancer treatment