Becoming a Mother after Breast Cancer Treatment
by Evelyn Mok-Lin, MD, and Glenn Schattman, MD
The opportunity to have children, raise a family, and experience the joys of motherhood is a very real prospect for many young women with breast cancer. While there are still thousands of women diagnosed with breast cancer each year, survivors are now living longer and healthier lives thanks in large part to advances in surgical and chemotherapy treatments. The American Cancer Society estimates that there are currently over 350,000 young women between the ages of 20 and 39 years old living with cancer in the U.S. Because there are so many reproductive-age cancer survivors who may want children in the future, the topic of fertility has become increasingly important to a woman’s treatment, recovery, and healing process.
If you had embryos, eggs, or ovarian tissue frozen prior to your cancer treatment and have now been cleared by your oncologist for pregnancy, you may have those cells thawed and transferred back into your body. Frozen embryos have the highest success rates, with up to a 50-percent chance of pregnancy per transfer. Frozen eggs – once thawed, fertilized with sperm, and transferred into the uterus as embryos – may also yield comparable pregnancy rates, depending on your age and the number of eggs you were able to have preserved. Embryo or egg freezing, while ideally completed prior to chemotherapy, may also be performed successfully soon after treatment, if done prior to significant decline in ovarian function. Removing and freezing an entire ovary, followed by subsequent thawing and transplantation of the ovary back into the body, is an experimental technique, but it may be a viable option for prepubertal girls and for women who are unable to undergo an ovarian stimulation cycle.
Dr. Glenn Schattman
If you did not undergo fertility preservation prior to treatment, you still have options. Despite receiving high doses of ovarian-toxic chemotherapy, many women are still able to conceive a child naturally. The chances of spontaneous pregnancy are highest for younger women who still have regular, monthly menstrual cycles after treatment.
If you are unable to conceive on your own, and if adoption is not a viable option for personal or legal reasons, in vitro fertilization (or IVF) is an excellent option with success rates that are often comparable to those of women without cancer. Sometimes, ovarian function can be significantly compromised from chemotherapy such that a woman experiences early menopause with little to no remaining ovarian function. In this case, IVF can be performed using eggs donated from another woman, which are then fertilized and transferred into your uterus. Because donors are typically young, healthy women in their 20s, pregnancy rates can reach as high as 70 percent.
All of these methods, when approved by your oncologist and performed by an experienced fertility specialist, are considered safe for cancer survivors. Researchers have found that fertility medications and naturally occurring pregnancy hormones do not increase the risk for cancer metastases or recurrence. In fact, many studies have found that women with a history of breast cancer who had children after treatment had improved survival rates compared to women who did not conceive. Whether this is due to an improvement in quality of life that motherhood can provide is unknown. What most experts can agree upon, however, is that motherhood is a wonderful journey that many breast cancer survivors can now experience because of an increased emphasis on fertility preservation.
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Dr. Glenn Schattman is an associate professor of obstetrics and gynecology and reproductive medicine at Weill Cornell Medical College in New York, NY, who specializes in infertility and fertility preservation. Dr. Evelyn Mok-Lin is a board-certified obstetrician/gynecologist completing a reproductive endocrinology and infertility fellowship at Weill Cornell Medical College.
This article was published in Coping® with Cancer magazine, May/June 2013.