For Younger Women, Breast Cancer Treatment Comes With the Fertility Factor

For younger women, a cancer diagnosis doesn’t just disrupt their day-to-day life; it also disrupts their fertility. Both chemotherapy and radiation can destroy eggs, and radiation to the pelvis can cause scarring to the uterus. “Chemo impacts fertility, which is why before starting, all women who still desire to have biological children should be offered the opportunity for fertility preservation,” says Dr. Susan Domchek, Executive Director of Basser Center for BRCA at Penn Medicine. “That’s critically important, and we have time to do that.”

Fertility preservation takes many forms, but egg or embryo freezing is most common. Daily hormone injections stimulate the ovaries and help multiple eggs grow, which are then retrieved and flash-frozen. Couples can also fertilize the eggs and freeze embryos instead.

But it doesn’t end there.

Amanda Kuhl and her husband successfully froze her eggs before her breast cancer treatment. Now in remission, she’s on Tamoxifen to prevent recurrence—which can be dangerous to a fetus. That coupled with an influx of pregnancy hormones has left Kuhl—and medical experts—conflicted about her having another baby.

Her oncologist said she could stop the medication in July to pursue pregnancy, then go back on it postpartum. Still, she worries that a pregnancy could lead to a cancer recurrence.

And then there are the costs. Egg freezing runs $8,000 to $15,000; IVF can start at $20,000. Pennsylvania doesn’t require insurers to cover fertility preservation for cancer patients, though PA Senators Tracy Pennycuick and Nick Miller recently proposed legislation to change that.

Early menopause can also be a concern. Dr. Domchek says oncologists are becoming more aggressive with estrogen-receptor-positive breast cancer, shutting off patients’ ovaries. “If you are 32 versus 65, that looks a lot different in terms of impact on your life,” she says, citing risks to bone and cardiac health alongside hot flashes, irritability and vaginal dryness. “If you are still dating and haven’t had children yet, and now you’re in menopause, you can imagine how disruptive this can be to a young woman’s life.”

Click here for more ways to Think Pink.