Fertility After Breast Cancer

The impact of breast cancer treatment on your fertility depends in large part on your age at the time of treatment. About 25,000 women younger than 45 are diagnosed with breast cancer each year. Factors other than age that affect fertility are the extent of the cancer and the type of cancer treatment. If you're finished with treatment, you may want to inform yourself about options for conceiving a child.

Am I still fertile?

A fertility specialist can run tests that will help to evaluate your fertility. Evaluation involves mutiple scans and blood tests over time. A fertility specialist might also recommend a partner evaluation (that is, a sperm count).

An initial assessment may include a measure of your follicle stimulating hormone or FSH, and a measure of estradiol. Both are measured on day 3 of your mentrual cycle. These may need to be done more than once as even "normal women" do not ovulate every month. In addition, your doctor may recommend an ultrasound evaluation of your ovaries to check egg development and the lining of your uterus.

If the results are within the normal range for fertility, there is a better chance that you can become pregnant. If you're menstruating, you're not necessarily fertile.

• Ask my doctor for a referral to a fertility specialist

• Ask about measurements of FSH and estradiol

• Ask about an ultrasound evaluation of my ovaries

Would a child have abnormalities?

Data on the outcome of pregnancies in cancer survivors have not shown any increase in birth defects, birth-weight effects, or sex ratios. It appears that women treated with chemotherapy who remain fertile are not at an increased risk of having children with abnormalities. However, in the first year after chemotherapy, women do have a higher incidence of miscarriage. Ask your doctor about research on rates of abnormalities in children born to women who've had your treatment regimen

Would pregnancy cause a recurrence?

Pregnancy after breast cancer does not appear to increase the risk of a cancer recurrence, although additional studies may show a risk in the future.

Breast cancer survivors are usually advised to wait 2 to 5 years after treatment ends before trying to get pregnant. This is because cancer is more likely to recur, if at all, during that time period. However, every year that passes is also a year of diminished fertility as you get older. Talk to your doctor about your specific circumstances. It may be recommended that you try to get pregnant sooner than 2 to 5 years from now, depending on your specific situation. The shortest wait time before trying to conceive is 6 months after chemotherapy has ended, to allow your body to fully recover. Talk to your doctor about how long you should wait before trying to get pregnant

I'm not getting support around my fertility

It's important to first recognize the natural grieving process of this difficult cancer diagnosis and treatment and then its impact on fertility. Being glad you surived your cancer diagnosis, your loved ones may not understand why fertility is important to you. As you educate yourself about fertility, you can educate those close to you. As they get used to the idea, they will hopefully support you in your desire to be a parent, however that happens, biologically or through adoption. Consider talking to your family members about why you want to become a parent. Share the information you are learning about the risks and benefits for you and your child.

Will my periods return?

The younger you are, the more likely your menses, or your periods, will resume. If you were beginning to approach menopause, it is much less likely that your periods will return. If they return, it is likely that menopause will come sooner than if you'd not had chemotherapy. Some women do not menstruate for 1 to 2 years after chemotherapy; they also find that they may not menstruate as long or as heavily as they would have before chemotherapy. Even with the return of menses, fertility is not assured.

If I am not fertile, Can I adopt?

Most adoption agencies do not rule out cancer survivors as potential parents, especially when a doctor writes that a survivor has a good prognosis. However, some agencies do require a certain amount of time to pass before allowing a survivor to be eligible.

It may help to have an adoption counselor or lawyer guide you through this process. Psychological support may help, too, especially if you are grieving that you can't have a biological child.

Network with other cancer survivors who are adopting by joining a listserv or computer bulletin board. Look into adoption agencies, and find out their requirements of cancer survivors as adoptive parents