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In many cases, treatment for breast cancer involves chemotherapy, radiation
therapy, or a combination of the two. These treatments can affect your
reproductive system and, as a result, your fertility.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs
work by attacking rapidly dividing cells, such as cancer cells. However, these
drugs also kill some healthy cells, including those involved in the production
of eggs, which also divide rapidly. The type of chemotherapy drug or drugs used,
the length of treatment, and the person's age at the time of treatment are all
factors that can affect fertility. In some cases, the effect of chemotherapy on
fertility is temporary, but it can be permanent.
Radiation therapy is a way of treating disease using radiation (high-energy
rays) or radioactive substances. Radiation kills cancer cells by interfering
with their growth and division. The potential for fertility problems due to
local radiation therapy for breast cancer is not as great as for chemotherapy
because the area affected by cancer is away from the reproductive organs.
However, because radiation beams often pass through healthy tissues, the organs
near the cancer site may be affected by the radiation, which can lead to either
temporary or permanent infertility. Radiation to the pelvic region may impair
fertility.
Factors that affect sexual desire can also be a problem for someone who may
want to become pregnant. For example, a decreased sex drive is a possible
complication of breast cancer treatment. This may result from hormonal changes
caused by the treatment or from fatigue that often accompanies cancer therapy.
In addition, breast cancer pain or treatment -- especially chemotherapy --
can cause nausea. Self-image may also be a problem. Breast cancer and its
treatment may leave physical and emotional scars. Time and counseling may help
overcome the mental and emotional side effects of breast cancer.
Be sure to discuss your concerns about fertility with your doctor before you
begin breast cancer treatment.
Can fertility be preserved after treatment for breast cancer?
There are ways for breast cancer patients to increase their chances of having
children following treatment.
- Cryopreservation. Cryopreservation is the process of freezing
and storing embryos (fertilized eggs) for later use. This involves first
stimulating the ovaries to make mature eggs (oocytes) that can be retrieved
and fertilized. The embryos can be implanted in the woman after she recovers
from breast cancer treatment or in a surrogate (a woman who carries the baby
when the natural mother is unable). Unfertilized eggs are more delicate and
can be easily damaged during the freezing process. For this reason,
cryopreservation of unfertilized eggs is less effective.
Improvements in the techniques of assisted reproduction -- such as in vitro
fertilization (a procedure in which thousands of sperm are placed in a
laboratory dish with an egg) and intracytoplasmic sperm injection (a
procedure in which a sperm is injected directly into an egg) -- have
increased the production of usable embryos for cryopreservation.
- Freezing ovarian tissue. One ovary is generally removed and
frozen for later use.
- Use of less toxic chemotherapy drugs. While some chemotherapy
drugs may cause less damage to the reproductive organs, these drugs may also
be less effective at treating breast cancer. Your oncologist can determine
if a less toxic chemotherapy drug is appropriate for your cancer treatment.
Researchers also are looking at new methods of treatment that spare the
reproductive system. These include the following:
- Hormonal suppression of the reproductive organs. This approach
involves using hormones to place the reproductive organs in a dormant
(inactive) state, shutting down your body's production of eggs. This process
seems to protect the cells that develop into eggs (germ cells) from damage
by chemotherapy. This approach is still considered investigational.
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