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Five Questions to Ask about Your Fertility after a Breast Cancer Diagnosis

More than 13,000 women under 40 are diagnosed with breast cancer each year in the United States. When a young woman receives a breast cancer diagnosis, one of the last things she may be thinking of is her future ability to have children. But it is an important consideration when making treatment decisions and consulting with physicians. Many breast cancer treatments can have a major impact on fertility.

After a breast cancer diagnosis, many (but not all) women may have four to six weeks to make decisions about preserving their fertility via techniques such as egg freezing. They should quickly become aware of their options, do their research and ask questions of their cancer specialists as well as get a referral to a reproductive endocrinologist. "[Cancer patients] deserve a consultation with a reproductive endocrinologist," says Margaret Graf Garrisi, M.D., medical director of assisted reproduction at IRMS St. Barnabas in New Jersey. "What people underestimate is the psychological benefit of hope. Whether they freeze anything or not, these women deserve the information to make that decision. And they tend to be very happy for the time spent and the knowledge that they get from a consultation."

1. Will My Cancer Treatment Affect My Fertility?

Breast cancer patients treated with surgery and localized radiation may not be at risk for infertility, but those treated with chemotherapy are. "Not only is it the type of chemotherapy and the dose, but it's also the age of the patient that determines whether you will be rendered menopausal or just temporarily not have your period," Dr. Garrisi explains. "But even younger women can have serious damage to their ovaries from something like cytoxin."

Another thing to consider is how long your treatment may last and whether it will delay your childbearing years long enough to pose a risk to your fertility.

2. Who Do I Talk to about Fertility Preservation?

If you have been diagnosed with breast cancer, talk to your oncologist and tell him or her you want to take steps to preserve your fertility. You will need a referral to a reproductive endocrinologist (fertility doctor). "If you're oncologist doesn't think to refer you to a reproductive endocrinologist, probably the next person would be your regular Ob/Gyn, and they send patients to reproductive endocrinologists all the time," Dr. Garrisi says.

Certainly, do your online research to find fertility doctors in your area.

3. What Techniques Are Available to Preserve My Fertility?

There are various options for fertility preservation. If you a woman who is married or has a partner, you may choose to freeze embryos (embryo cryopreservation). If you are single, you may want to freeze your eggs (oocyte cryopreservation) or use donor sperm to freeze embryos. Both of these techniques require daily injections of synthetic hormones to stimulate your ovaries in order to collect multiple eggs during a menstrual cycle, as well as an outpatient surgical procedure to retrieve the eggs.

"We usually prefer to start them in the early follicular phase of their menstrual cycle, but starting it even after someone has ovulated, you can still get reasonable eggs," Dr. Garrisi says. "The endometrium would be out of sync, but you're freezing all the eggs or embryos anyway and not putting them back in during that cycle, so it seems to be a viable alternative as opposed to stretching out and waiting for another menstrual cycle.

"Now that we're starting people on medications during any time of their cycle, we can usually get the treatments for stimulating the ovaries for egg retrieval in between 10 days and two weeks," she continues. "That would necessitate that they are delaying cancer treatment, and the oncologist would have to say whether that was reasonable or not depending on the seriousness of their problem."

Other, more experimental therapies include freezing ovarian tissue (ovarian cryopreservation) by surgically removing it, freezing and reimplanting later, as well as ovarian suppression before cancer therapy, in which hormonal therapies are used to suppress ovarian function and protect eggs during cancer treatment.

4. Are Fertility Preservation Methods Successful?

Embryo freezing is the most successful technique and vitrification has improved egg freezing dramatically. Ovarian tissue freezing has produced approximately 30 successful pregnancies. The data on success rates of ovarian suppression treatments are conflicting.

5. How Do I Pay for Fertility Preservation?

Fertility preservation techniques such as ovarian tissue preservation, egg freezing or embryo freezing can cost between $12,000 and $20,000 and will probably not be covered by insurance companies. Still, fertility preservation advocates recommend that cancer patients have their fertility doctors code and submit their treatment as cancer treatment. Ovarian suppression methods are less expensive and may be covered by insurance if they are administered in the oncologists office.

There are organizations such as Fertile Action and Livestrong Fertility that can help patients with discounts and/or financial support for fertility preservation.

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