No Fertility Treatment
How can this delay my treatment? This will not delay your treatment.
How much will this cost? There is no extra cost.
Can this interact with my hormone receptor-positive breast cancer? This does not interact with treatment.
Your doctor will likely recommend taking hormonal therapy for 5 to 10 years. If you want to get pregnant in this time, speak with your doctor about safely taking a break from hormonal therapy while you get pregnant and give birth.
Does my age impact this?
Yes. Women are born with all the eggs they will have and chemotherapy can destroy some of those eggs. Women with larger reserves of eggs at the time of diagnosis and treatment are more likely to regain ovarian function after treatment. Women who are starting with a reduced ovarian reserve before chemotherapy are at a higher risk of infertility after treatment.
Do I need a partner or sperm donor?
No. You don’t need a partner or sperm donor until you are ready to get pregnant.
More About No Fertility Treatment
You may decide to not take medical steps to protect your fertility before or while you’re getting cancer treatment. There is still a chance that you will have fertility after active treatment. The younger you are, typically the better that chance is. Talk to your doctor about chemotherapy medicines and other treatments that are less likely to affect your fertility, but it’s important to understand that all cancer medicines carry some risk. If you lose your ovarian reserve or go into permanent menopause, you cannot get eggs from your ovaries in the future. Other options for raising a family, like adoption and egg donation, are likely still available.
Surrogacy with Egg Donation
How can this delay my treatment? This will not delay cancer treatment.
How much will this cost? The cost for the in vitro fertilization procedure is around $12,000. Using an egg donor can raise the cost of family building based on how you obtain donor eggs. In some cases, you can purchase eggs from an egg bank — these are frozen eggs that are sold in specific quantities. In other cases, you may pay to put an egg donor through a stimulation cycle to retrieve as many eggs as possible. In this case, all retrieved eggs typically belong to you. Both of these methods can increase the total cost of IVF by sometimes as much as $15,000 to $20,000. Each individual attempt at an embryo transfer can bring an additional charge.
Can this interact with my hormone receptor-positive breast cancer?
You may have to interrupt long-term treatments in order to attempt pregnancy using a donated egg. Your doctor will likely recommend taking hormonal therapy for 5 to 10 years. If you want to get pregnant in this time, speak with your doctor about safely taking a break from hormonal therapy while you attempt pregnancy.
Does my age impact this?
Some fertility centers restrict how old you can be when you try to get pregnant using a donated egg. Be sure to ask your provider if there is an age limit for the procedure at your center.
Do I need a partner or sperm donor? You will eventually need sperm from either a partner or a donor when you are ready to attempt pregnancy.
More About Surrogacy with Egg Donation
There are a variety of factors that contribute to infertility after cancer treatment. In some cases, your ovarian reserve, the amount of eggs left in the ovaries, is too low or gone. As women age, the quality of eggs also decline and this can lead to more difficulties in getting pregnant and a higher risk of miscarriage or birth defects. If after breast cancer treatment, you find that your eggs aren’t able to be used to attempt pregnancy, it may still be possible for you to carry a pregnancy using an egg from someone else (an egg donor).
You can find an egg donor through an agency that provides this service, an egg bank, or through a personal connection. This process can be complex and there are strict guidelines in finding and using an egg donor. You should talk to a fertility specialist before searching for an egg donor on your own. Some clinics only work with certain agencies or egg banks. If you’re using an egg donor that you already know, there are restrictions that you should be aware of before you move forward in this process. Once you get eggs from a donor, those eggs are fertilized with sperm from your partner or a sperm donor and if successful, an embryo is created. That embryo can then be transferred to your uterus to attempt a pregnancy. Each state has laws that dictate the use of donor eggs and sperm, so it is important to speak with a doctor who understands those laws before moving forward.
Adoption
How can this delay my treatment? This would not delay treatment.
How much will this cost? Adoption costs can vary widely depending on how you prefer to go through the process.
Adopting a child in foster care may have no charge, but often comes with other out-of-pocket expenses. Many parents hire a private agent to help with this process.
Adopting a baby through a private agency can cost $20,000 to $40,000, which includes a number of charges such as a home study, placement services, medical and legal expenses for the birth mother, and a number of other legal fees and requirements.
Can this interact with my hormone receptor-positive breast cancer? Adoption would have no effect on hormone receptor-positive breast cancer.
Does my age impact this? In most states, there are no laws preventing you from adopting at an older age. But private agencies may have limits on how old a person can be to adopt from them. Usually, these limits are set at age 50 and older. Birth mothers often request younger parents adopt their baby, which may make it harder to find a match if you choose to adopt a baby through an agency if you’re older.
Do I need a partner or sperm donor? You do not need a partner to adopt, but there may be added challenges if you are single. State laws and the policy of certain agencies may give priority to married couples over single applicants.
More About Adoption
Adoption gives you the chance to raise children regardless of your ability to get pregnant. There are a number of ways to adopt children, such as adopting a child from foster care or adopting a baby through a private agency. Each way has its own considerations. Are you open to adopting an older child? Are you able to afford a private agency to find a baby up for adoption? Do private agencies have requirements that make it harder for you to adopt?
Some agencies require you to submit your health history and do not accept people with a history of cancer. The Oncofertility Consortium at Northwestern University keeps a list of agencies that are open to people who have had cancer.
You may want to work with a lawyer that specializes in adoption, even if you are thinking about adopting from foster care.
Ovarian suppression
How can this delay my treatment? You can start taking ovarian suppression medicine right away, and it should not delay treatment.
How much will this cost? Up to $500 a month, which comes out to $6,000 for a year of treatment. If your doctor recommends ovarian suppression as part of your breast cancer treatment plan, it may be covered by insurance.
Can this interact with my hormone receptor-positive breast cancer? No. By shutting down the function of your ovaries, these medicines stop much of the estrogen and progesterone production in your body. This may make other medicines, like aromatase inhibitors, available to you and lower the risk of cancer returning, but this is still being studied.
Your doctor will likely recommend taking hormonal therapy for 5 to 10 years. If you want to get pregnant in this time, speak with your doctor about safely taking a break from hormonal therapy while you get pregnant and give birth.
Does my age impact this? Yes. Ovarian suppression may protect you from the long-term effects of breast cancer treatments and help your period return after treatment ends. The younger you are, the more likely it is that you will start having periods again. If you are in your mid-30s or older, it is less likely that your periods will return, even with ovarian suppression.
Do I need a partner or sperm donor? No. The goal of ovarian suppression to protect ovarian function so you may attempt pregnancy when active treatment ends. You won’t need a partner or sperm donor until you are ready to become pregnant.
More About Ovarian Suppression
Some studies have shown that medicines called gonadotropin-releasing hormone agonists (GnRH agonists) may protect the ovaries from the harsh effects of chemotherapy. These medicines shut down or suppress your ovaries. The medicine may cause menopause-like symptoms for as long as you take them.
GnRH agonists are still considered experimental for fertility preservation. Note that this approach does not take the place of standard methods of preserving your fertility, such as freezing eggs and embryos.
The GnRH agonists are:
- goserelin (Zoladex)
- leuprolide (Lupron)
- triptorelin (Trelstar)
Ask your doctors to be specific about what kind of ovarian suppression they recommend. Some doctors use “ovarian suppression” or “ovarian ablation” to mean the same thing. Ovarian ablation can also mean surgery to permanently remove your ovaries.
GnRH agonists are given as an injection once a month, every 3 months, or as an implant that lasts 3 months.
Side effects may include
- bone thinning
- bone pain
- fatigue
- headache
- hot flashes
- insomnia
- joint and muscle aches
- loss of sexual interest
- mood changes
- sweating
- vaginal dryness
- weight gain
Ovarian tissue freezing
Freezing ovarian tissue is still considered experimental, but guidelines from the American Society of Clinical Oncology say new and upcoming evidence may change that in the near future.
How can this delay my treatment? In this experimental procedure, ovarian tissue is removed in a single operation and should not significantly interfere with starting treatment. The tissue should be removed before starting chemotherapy. Depending on your treatment plan and the availability of your fertility specialist, some treatment may be delayed to complete the operation before you begin chemotherapy.
How much will this cost? Ovarian tissue freezing is an experimental procedure so the cost can vary significantly based on the study site. Because it is experimental, insurance may not cover the costs associated with this option. In the future, it may be possible to grow eggs from the tissue or it may be possible to transfer the tissue back to your body. Both of those options will have additional costs and both are considered experimental at this time.
Can this interact with my hormone receptor-positive breast cancer? Ovarian tissue freezing does not require hormones to stimulate egg production and will not affect hormone receptor-positive breast cancer.
Your doctor will likely recommend taking hormonal therapy for 5 to 10 years. If you have the frozen ovarian tissue transplanted back to your body, it may cause your hormone status to change and that can affect which hormonal therapy you are given. If you are interested in trying to get pregnant at the time of your tissue transplantation, you must first speak with your doctor about safely taking a break from hormonal therapy while you attempt pregnancy.
Does my age impact this? Yes. Because women are born with all the eggs they will ever have, age impacts both the quantity and quality of eggs in women. This is an experimental procedure and centers should have strict age guidelines on who can enroll in this process.
Do I need a partner or sperm donor? No. Ovarian tissue is frozen with immature eggs present. In the future, if this tissue is transplanted, the goal would be that eggs from that tissue would mature inside the body, ovulate or release from the ovary, and potentially result in pregnancy after sexual intercourse. Studies are ongoing to determine the effectiveness of this as well as attempting to grow eggs from the tissue directly outside the body. Both options are considered experimental.
Some women are diagnosed with breast cancer before they’ve finished having children or even had the chance to start a family. Certain treatments can increase your risk of infertility, so it’s important to consider this before starting treatment.
Some types of breast cancer treatment can lead to medical menopause, meaning that your periods stop and your ovaries no longer produce eggs. Medical menopause is sometimes temporary, lasting only during treatment and for a few months afterward, but it can be permanent. The risk of permanent menopause is greatest for women in their mid-30s and older.
If you’re premenopausal and diagnosed with hormone receptor-positive breast cancer, your doctor will likely recommend the estrogen-blocking medicine tamoxifen for 5 to 10 years after initial treatment ends. Although tamoxifen doesn’t put you into menopause, you shouldn’t get pregnant while taking it because it can harm a developing fetus. Depending on your age, you might be concerned about waiting several years to attempt pregnancy.
If you think you might want biological children in the future, you can talk to your doctor about ways to preserve your fertility before starting treatment. Many women consider options such as freezing embryos (their own eggs fertilized with sperm from a partner or donor) or freezing eggs for later use. Another newer option is ovarian tissue freezing.
What is Ovarian Tissue Freezing?
Ovarian tissue freezing, also called ovarian cryopreservation, starts with a minor surgery to remove one of your ovaries. The outer layer of the ovary, known as the cortex, is separated from the rest of the tissue, sliced into multiple strips, and frozen. The cortex contains the immature eggs released every month as part of your menstrual cycle.
When you finish cancer treatment and want to get pregnant, a slice of that ovarian cortex is thawed and then implanted during another minor surgery, usually on the remaining ovary. Over the next few months, the implanted tissue should heal and connect to nearby blood vessels. The hope is that in 3 to 6 months, the tissue will start functioning again: hormone cycles come back, the body starts producing eggs, and periods return. Once your periods come back, you can try to get pregnant.
In selected cases, you might need to have in vitro fertilization, or IVF, to assist you in getting pregnant. IVF could be used if you don’t get pregnancy naturally or if you don’t have a male partner and wish to use donor sperm. Also, there are situations where the specialist has to implant the thawed ovarian tissue in the pelvic area but not directly on the ovary—for example, if you’ve had both ovaries removed or you have scar tissue on the ovary. To perform IVF, the specialist would harvest eggs from the implanted tissue, fertilize them in a lab, and then place the resulting embryos into the uterus.
Once the ovarian tissue starts functioning, it can last 4 to 8 years. If the implanted tissue stops working, or you want to have more children after 4 to 8 years, additional strips of tissue can be thawed and implanted.
Although the first ovarian tissue freezing and implantation procedure was performed in 1999, it’s often described as “experimental.” It’s only available in highly specialized centers, and fertility specialists are still investigating the best ways to do it. Ovarian tissue freezing is the only preservation option for girls who haven’t reached puberty and need cancer treatments that affect fertility, since their bodies are not yet producing eggs. And for younger women in their late teens and 20s, it can be a good option.
According to a 2017 study, about 37 percent of women who had ovarian tissue freezing went on to have successful pregnancies. The younger the woman was at the time of tissue removal, the greater the likelihood of success. For those 35 and older, which most women with breast cancer are, it’s not likely to be successful.
Who Can Get Ovarian Tissue Frozen?
The most commonly recommended fertility preservation option for women diagnosed with breast cancer is freezing embryos, followed by freezing eggs.
Ovarian tissue freezing might be considered if:
- A doctor recommends that chemotherapy start without delay: Egg or embryo freezing can delay the start of chemotherapy for several weeks. If you need chemotherapy as your initial treatment for breast cancer, or as soon as possible after surgery, you and your doctors might not want to wait that long. Ovarian tissue can be removed right away for freezing.
- You don’t want to take hormones to stimulate the ovaries: Women who want to freeze eggs or embryos need to take high doses of hormones to stimulate the ovaries to produce multiple eggs. If the cancer is hormone receptor-positive, there may be concerns about putting extra hormones into the body. Although you would be given high doses of aromatase inhibitors at the same time to keep estrogen levels low, you and your doctor still might prefer to avoid high doses of hormones.
- It’s likely that the ovarian tissue contains enough eggs: The younger you are at the time of ovarian tissue freezing, the better the odds of success when the tissue is re-implanted. If you’re older than your mid-30s or have had prior chemotherapy treatments, the odds of success are slim.
- You’re not at high risk of ovarian cancer: If you have a BRCA1 or BRCA2 mutation that increases ovarian cancer risk, freezing and later implanting ovarian tissue may not be the best choice for you.
- You want ovarian tissue freezing in addition to freezing eggs or embryos: With egg freezing, only about 10 to 15 eggs can be retrieved; even fewer embryos may result if a woman decides to fertilize the eggs before freezing. In contrast, a slice of ovarian tissue can contain hundreds or even thousands of immature eggs.
What are the Pros and Cons of Ovarian Tissue Freezing?
The advantages of ovarian tissue freezing over egg or embryo freezing are:
- it doesn’t have to delay treatment
- it does not require taking hormones. If you have hormone receptor-positive breast cancer, this may be a relief.
- each slice of tissue contains many more eggs than could be harvested during egg retrieval for egg or embryo freezing
- it returns your body to working as it did before menopause — releasing hormones, maturing an egg each month, and having regular periods
The main disadvantages of ovarian tissue freezing are that it
- is only available at highly specialized fertility centers
- is only recommended for women in their 20s and early 30s, and girls who have not yet reached puberty
- requires at least two surgeries
More About Ovarian Tissue Freezing
Women with breast cancer in their mid- to late-30s and 40s are not likely to have success with it. Also, women who had hormone receptor-positive breast cancer might be concerned about restoring the body’s production of estrogen.
According to the Society for Assistive Reproductive Technology, embryo freezing has the highest rate of success among fertility preservation methods, with about 45 percent of implanted embryos leading to delivery of a baby during a given cycle. If you choose to have ovarian tissue freezing, your team may suggest freezing embryos and eggs as well.
Embryo (fertilized egg) freezing
How can this delay my treatment?
Embryo freezing takes about 2 weeks to complete.
Each month during ovulation, your ovaries usually release one egg. But when you freeze embryos for later use, your doctor will try to collect as many eggs as possible. To do so, you will give yourself hormones that encourage your ovaries to mature more than one egg.
The time from when you begin stimulation medicines until your egg retrieval can take anywhere from 10 to 15 days. After your eggs are collected by a doctor, the lab will fertilize them with sperm. In the following days, you will be told how many of your eggs successfully fertilized and how many embryos are frozen. In some cases, you can accomplish a cycle of embryo freezing after breast surgery and before any additional therapy begins. If you need chemotherapy before surgery, an embryo freezing cycle should be started as soon as possible for a minimal delay in starting chemotherapy.
How much will this cost?
Embryo freezing may cost between $10,000 and $15,000. The embryo freezing costs will vary based on the individual clinic that you are using.
Other costs may include yearly storage for the embryos and medicines for stimulation. When you are ready to use these embryos, having the eggs thawed and implanted can cost another $5,000. The total cost will vary depending on where you get care, what (if anything) your insurance will cover, and additional charges such as appointments, tests, and travel.
It is possible that the procedure may be covered by your insurance. To be sure, contact your insurance provider. If it is not covered by your insurance, you may be eligible for financial assistance through national programs that help aid in the cost of fertility preservation for cancer patients.
Can this interact with my hormone receptor-positive breast cancer?
There is no evidence that using hormones for the embryo freezing process affects hormone receptor-positive breast cancer.
To help prevent breast cancer from coming back, your doctor may recommend taking hormonal therapy for 5 to 10 years. If you want to attempt pregnancy during that time, speak with your doctor about safely taking a break from hormonal therapy while you get attempt pregnancy. Hormonal therapies can harm a fetus if taken during pregnancy. You should not attempt pregnancy while actively taking hormonal therapy.
Does my age impact this?
Because women are born with all the eggs they will ever have, the older a woman is, the more likely the eggs are to have problems that can lead to an increase in birth defects and miscarriage.
Some fertility centers restrict how old you can be when you attempt pregnancy. Be sure to ask your provider if there is an age limit for the transfer of a fertilized egg at your center.
Do I need a partner or sperm donor? Yes. After the egg retrieval, the eggs are fertilized in the laboratory and allowed to grow. Not all eggs will fertilize and not all fertilized eggs will continue to grow. The fertility doctor’s office will keep you updated on the progress of your embryos and when they are frozen.
If you use sperm from a partner, that partner will share rights over the embryos with you unless you’ve both signed a contract assigning all rights to you. When you are attempting pregnancy with a frozen embryo, both you and the partner used to create the embryos will need to sign additional consent forms. Sperm donors typically have to decline their rights when they donate, which means you alone have rights over the embryo if you use a sperm donor.
More About Embryo (Fertilized Egg) Freezing
The best time to go through embryo freezing is before breast cancer treatment begins Stimulation involves giving yourself hormone injections for about 2 weeks. These medicines tell the ovaries to mature multiple eggs at once, instead of the single egg that is usually matured each month. Your fertility doctor may also have you take a medicine like tamoxifen or an aromatase inhibitor during stimulation, to try to decrease the rise in estrogen that occurs because of stimulation medicines.
To remove the eggs from your body, a doctor will insert an ultrasound device into your vagina to find the mature eggs stored in your ovaries. A needle is then guided into the ovary to remove each egg. The eggs are then fertilized in a lab, with sperm from your partner or a sperm donor. The fertilized egg will be allowed to grow, and if a healthy embryo develops it is frozen for use after breast cancer treatment and your oncology team has cleared you to attempt pregnancy or you choose to use a surrogate to carry the pregnancy.
If you have a family history of breast cancer or know you carry a gene mutation related to cancer, it is possible to test the embryo to see if it also carries the mutation. Your fertility specialist will have more information on these tests.
When you are ready to attempt pregnancy, the embryos are thawed and implanted into your uterus at your doctor’s office.
Egg or embryo freezing is the standard-of-care approach to preserve fertility.
It can be stressful to make decisions about fertility right after a breast cancer diagnosis. You may want to get started with cancer treatment quickly, or your doctors might recommend neoadjuvant therapy, chemotherapy before surgery. Perhaps you have not thought about having children yet, and cancer is now forcing you to do so.
Talk with your oncologist about timing and any concerns you have — there may be ways to make a schedule work for you and your treatment plan. Your oncologist can also communicate directly with the fertility doctor to ensure the delay to starting breast cancer treatment is minimal.
Oocyte (unfertilized egg) freezing
How can this delay my treatment? Egg freezing takes approximately 2 weeks to complete.
Each month during ovulation, your ovaries usually release one egg. But when you freeze eggs for later use, your doctor will try to collect as many eggs as possible. To do so, you will give yourself hormones that encourage your ovaries to mature more than one egg.
The time from when you begin stimulation medicines until your egg retrieval can take anywhere from 10 to 15 days. In some cases, you can complete a cycle of egg freezing after breast surgery and before any additional therapy begins. If you need chemotherapy before surgery, an egg freezing cycle should be started as soon as possible for a minimal delay in starting chemotherapy.
How much will this cost? The egg freezing process can cost between $10,000 and $15,000, with prices that vary depending on where you get care, what (if anything) your insurance will cover, and additional charges such as appointments, tests, and travel.
Other costs may include yearly storage for the eggs and medicines for stimulation. When you are ready to try to get pregnant you will have to pay for the eggs to be thawed, fertilized, and placed in your uterus which can run about $5,000.
It is possible that the medical fertility preservation procedure may be covered by your insurance. To be sure, contact your insurance provider. If it is not covered by your insurance, you may be eligible for financial assistance through some national programs that help with the cost of fertility preservation for cancer patients.
Can this interact with my hormone receptor-positive breast cancer? There is no evidence that using hormones for the egg freezing process affects hormone receptor-positive breast cancer.
To help prevent breast cancer from coming back, your doctor will likely recommend taking hormonal therapy for 5 to 10 years. If you want to get pregnant during that time, speak with your doctor about safely taking a break from hormonal therapy while you attempt pregnancy. Hormonal therapies can harm a fetus if taken during pregnancy. You should not attempt pregnancy while actively taking hormonal therapy.
Does my age impact this? Yes. Because women are born with all the eggs they will ever have, the older a woman is, the more likely the eggs are to have problems that can lead to an increase in birth defects and miscarriage.
Some fertility centers restrict how old you can be when you attempt pregnancy. Be sure to ask your provider if there is an age limit for the transfer of a fertilized egg at your center.
Do I need a partner or sperm donor? Not now. Eggs can be frozen without being fertilized, so you will not need sperm from a partner or donor until you are ready to attempt pregnancy. Legally, this means that these eggs belong to you and you alone, even if you are in a domestic partnership or marriage.
More About Oocyte (Unfertilized Egg) Freezing
The best time to undergo egg freezing is before breast cancer treatment like chemotherapy begins. The process includes getting hormone injections for about 2 weeks. Medicines signal the ovaries to mature multiple eggs at once, instead of the single egg that is usually matured each month. Your fertility doctor may also have you take a medicine like tamoxifen or an aromatase inhibitor during stimulation, to try to decrease the rise in estrogen that occurs because of stimulation medicines.
To remove the eggs from your body, a doctor will insert an ultrasound device into your vagina to find the mature eggs stored in your ovaries. A needle is then guided into the ovary to remove each egg. The eggs are then frozen, without being fertilized, for use after your breast cancer treatment ends and your oncology team has cleared you to attempt pregnancy or you choose to use a surrogate to carry the pregnancy.
When you are ready to attempt pregnancy, the eggs are thawed and fertilized with sperm from either a donor or your partner. If the fertilized egg develops into a healthy embryo, it can be implanted into your uterus at your doctor’s office.
If you have a family history of breast cancer and know you carry a gene mutation related to cancer, it is possible to test the embryo to see if it also carries the mutation. Your fertility specialist will have more information on these tests.
Egg and embryo freezing are considered the standard-of-care approach to preserve fertility. While freezing embryos has a higher pregnancy rate, egg freezing is a good option that does not require you to have a partner or sperm donor.
It can be stressful to make decisions about fertility right after a breast cancer diagnosis. You may want to get started with cancer treatment quickly, or your doctors might recommend neoadjuvant therapy, chemotherapy before surgery. Perhaps you have not thought about having children yet, and cancer is now forcing you to do so.
Talk with your oncologist about timing and any concerns you have — there may be ways to make a schedule that works for you and your treatment plan. Your oncologist can also communicate directly with the fertility doctor to ensure the delay to starting breast cancer treatment is minimal.