Planning for Pregnancy After Cancer: 3 Ways to Preserve Your Fertility

Up to 40% of people will at some point receive a cancer diagnosis, and we can all see and feel its effects in our families and across our communities. When you're facing cancer but still dream of having children in the future, what are your options? Let's explore them together.

Skip to a section:

• Breast Cancer & Fertility
• Why consider fertility preservation?
• Fertility Preservation Methods
• Egg Freezing
• Estrogen-Sensitive Cancer Types
• Embryo Freezing
• Ovarian Tissue Cryopreservation
• What are GnRH agonists?
• Planning for Pregnancy After Cancer
• Using a Gestational Carrier (Surrogate)
• Other Family-Building Options
• Hope for Future Family Building

Breast Cancer & Fertility

Most of us know at least one person whose life has been touched by breast cancer, and when you read the statistics, it's not hard to see why. One in eight women will receive the diagnosis in their lifetime, making it the most common cancer in the United States (aside from skin cancer).

While most new cases occur in those who are postmenopausal, 19% of breast cancer cases actually occur in younger, reproductive-aged women. For those facing cancer who still dream of growing their family in the future, it can be overwhelming and stressful to juggle a new diagnosis and treatment options with concerns about future fertility and pregnancy.

Thankfully, there are various methods of fertility preservation that offer ways to help protect your current fertility - before it is potentially damaged by cancer treatment.

Why consider fertility preservation?

During cancer treatment, the very chemotherapy that may save a woman’s life can also damage and deplete her eggs, making future conception more difficult (or impossible). The risk of infertility depends on the type and dose of medication, as well as the age of the patient at the time of treatment.

Furthermore, the likelihood of becoming pregnant decreases naturally as we age, and delays due to cancer treatment and recovery can increase fertility challenges.

As a reproductive endocrinologist, I frequently work with newly diagnosed cancer patients to discuss their options for fertility preservation, so that each person can achieve their personal family-building goals.

Fortunately, in the midst of battling this terrible, indiscriminate disease, there is hope for the future. We have many ways to help people facing cancer preserve their fertility so they can grow their family when they're ready.

Fertility Preservation Methods

1. Egg Freezing

Egg freezing is the process in which mature eggs are removed from the ovaries and frozen for potential use in the future. In order to freeze eggs prior to breast cancer treatment, a woman takes injectable medications to stimulate the ovaries for 10 to 14 days.

The goal is to mature multiple eggs simultaneously, which will then be removed during an egg retrieval procedure and frozen in the embryology laboratory.

When a woman decides to use frozen eggs in the future to build her family, they are thawed and fertilized with sperm to create embryos, which can then be transferred into the uterus directly, or after genetic testing.

Note: This process can be started very quickly and at any point in a woman's menstrual cycle, an important consideration when a patient needs to start cancer treatment as soon as possible. For example, a breast cancer patient could complete a preservation cycle in the time period between breast surgery and chemotherapy or radiation.

Estrogen-Sensitive Cancer Types

Additionally, since some forms of cancer (such as breast and endometrial) are sensitive to estrogen, and a woman's estrogen levels typically rise during an ovarian stimulation cycle, a medication called Letrozole can be given to lower the body's exposure to estrogen for the duration of the treatment.

Meet Arianna

After receiving concerning mammogram results and learning she carries the BRCA gene, Arianna chooses to freeze her eggs before undergoing preventative surgery.

2. Embryo Freezing

Some women with partners (or a sperm donor) will instead opt to create and freeze embryos (instead of eggs) prior to undergoing cancer treatment. The initial part of the embryo freezing process is the same as it is with egg freezing, but after ovarian stimulation and egg retrieval, the designated sperm is used to fertilize the eggs and create embryos.

Those embryos are then cultured in the embryology laboratory and are typically frozen at the blastocyst stage (Day 5 of the embryo’s development). Blastocyst embryos can be safely tested for chromosomal abnormalities, or even for cancer-causing genes (such as BRCA) in women that have a genetic predisposition to cancer.

3. Ovarian Tissue Cryopreservation

Those who need to begin treatment urgently and do not have time to undergo an egg or embryo freezing cycle may also have the option to cryopreserve their ovarian tissue instead. Laparoscopic surgery is performed to remove part of one ovary, and this tissue is then divided into pieces and frozen for the future. 

When a woman wants to build her family later on, a piece of that tissue will be thawed and surgically transplanted onto her existing ovary. Some of these tissue grafts will become hormonally active and actually ovulate eggs in the future. Pretty incredible, right?

This method was considered experimental until a few years ago, but over 200 babies have now been born with the help of ovarian tissue transplantation!

What are GnRH agonists?

During chemotherapy treatment, medications called gonadotropin-releasing hormone (GnRH) agonists can be given to suppress a woman’s hormones. This helps keep the ovaries "quiet" in order to make the eggs inside less susceptible to damage. 

This medication may reduce the chances of going into menopause during cancer treatment, but the degree of benefit that it provides is still a matter of debate. It is not a substitute for the other methods of fertility preservation listed above, but can be offered in addition to these treatments.

Planning for Pregnancy After Cancer

Deciding when to become pregnant after cancer treatment is a complex choice, influenced by many factors. The type of cancer, stage and need for ongoing treatment all play a role in determining a safe time to conceive. It is very important to discuss these issues with an oncologist prior to proceeding with pregnancy. 

Most of the time, women are advised to wait at least a few years after the completion of treatment before trying to conceive. If a cancer is estrogen-sensitive and long-term hormonal suppression is required, the recommendation may be to wait significantly longer.

Using a Gestational Carrier (Surrogate)

For women with estrogen-sensitive cancers and/or those taking long-term hormonal suppression to reduce the risk of cancer recurrence, another option is to build their family with the help of a gestational carrier, also known as a surrogate. 

An embryo created prior to cancer treatment (or an embryo created after treatment with previously frozen eggs) can be transferred into the uterus of a gestational carrier, who carries the pregnancy but has no genetic link to the baby.

This option allows for healthy, safe, family building for women who would have a high risk for cancer recurrence if they pursued pregnancy.

Meet Erin

A breast cancer survivor shares the story of her shocking cancer diagnosis and making the decision to pursue IVF and surrogacy to become a mother.

Other Family-Building Options

Those who do not (or cannot) preserve their fertility before cancer treatment do still have other options for expanding their family.

If they do not ultimately conceive on their own, cancer survivors may opt to utilize a donated egg or embryo to become pregnant, or pursue public or private adoption pathways. The bottom line is that there are many different options, and help is always available for those who want to grow their families after beating cancer.

Hope for Future Family Building

Understandably, a new cancer diagnosis can evoke overwhelming feelings of fear and uncertainty about the future. This can be particularly difficult for premenopausal women that still wish to grow their families. The good news? Women of reproductive age facing a cancer diagnosis still have many options to make their dreams of motherhood a reality. 

Additionally, many patients who pursue egg freezing and embryo freezing often report that the experience is hopeful and empowering during an otherwise challenging time.

By exploring fertility preservation and planning for any future pregnancies prior to cancer treatment, women can keep their options open and retain more control over when (and how) they choose to expand their families.