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JOURNAL

Fertility Preservation: Young Women with Breast Cancer

May 6, 2021

Choosing the path of motherhood is a courageous and selfless act. For some of us, it is simply a calling. But for many young women, it is not so clear. Especially when facing a breast or gynecological cancer diagnosis, the way forward can suddenly become fraught with painful choices.

This week, as we prepare to celebrate Mother’s Day, we want to discuss a sensitive and honest topic with young women facing cancer – the consideration of fertility preservation. While this topic may trigger sadness, anxiety and uncertainty, understanding the landscape of options can help us better prepare for the way forward. 

An Antidote to Fear

When we’re filled with fear – such as the fear of making the wrong choice – everything feels impossible. Speaking about her book, Fear Is Not An Option, author Monica Berg explains that such emotions feed stagnation and hold us back from making the decisions that can lead to our best lives. That is why it is so important to battle fear with better understanding and information that can ease the anxiety surrounding cancer treatments and their impacts on our family planning. It is this very anxiety, according to Ann Partridge, M.D., who leads a clinic for young breast cancer survivors at The Dana-Farber Cancer Institute, that has held many young women back from exploring fertility options. “Twenty years ago, everybody was afraid that undergoing fertility preservation, or conceiving after breast cancer, was going to add fuel to the fire,” Dr. Partridge states. These concerns are certainly understandable. Young women who face a breast cancer diagnosis may feel forced to make difficult and unfair decisions about their health. Delaying treatments like chemotherapy, which can lead to infertility later, or pausing post-cancer hormone blockers (which can last up to five years), further complicate the issue. Simply put, family planning for women is complex. Fortunately, according to current research, residual risks about post-cancer births and pre-treatment fertility treatments are lowering. 

Understanding Our Bodies

Everyone’s breast cancer journey is different. There is no rulebook or one-size-fits all solution to treatment. Just as our bodies are unique, the effect on our fertility and family planning options are as well. Experts at the American Cancer Society generally recommend that women wait up to two years after cancer treatments before becoming pregnant to reduce the risk of their cancer returning. Yet for those of us who have undergone chemo or radiation therapy to the pelvis, there is a real risk of menopause occurring up to twenty years ahead of schedule! That’s significant for many individuals, according to the Centers for Disease Control, as more American women are delaying childbirth than ever before. Not everyone will experience these results, however. Some of us will experience few to no issues in our reproductive health. 

We Do Have Options

Knowing that the residual risk to post-cancer births is lowering, and that we may or may not experience challenges, is the first step. The second step is to better understand the various options available to help us prepare for the road ahead. While our first choice may be to have a natural pregnancy, other paths are no less fulfilling or important. For many of us, having a discussion now can help diminish the fear and pressure when considering alternate steps toward motherhood. Egg donation, surrogacy and adoption can take additional time and resources that may be worth looking into ahead of time. Additionally, the laws surrounding these options do vary from state to state. 

Be Informed: Taking The Right Steps Now  

When we first learn that we have breast or gynecological cancer, fertility planning is just one of the many decisions in a whirlwind of important discussions and medical conversations that take place. We have so many questions before us, and it may feel overwhelming. Here are some simple steps we can take to ensure we’re informed and protected:

  1. Bring it up: When it comes to fertility planning, we can’t assume our doctor knows whether or not this is critical to us. 
  2. Now, not later: The American Cancer Society recommends speaking to our whole cancer team (oncology, radiology, etc.) before any treatments, not during or after.
  3. Discuss it: Asking to be referred to a fertility specialist, even if we’re unsure of what we want to do—especially if we’re unsure—can help us learn more and make an informed decision. 
  4. Get help: Investing in the process with the aid of available resources can eliminate the potential of being blindsided by costs.  

Being diagnosed with cancer can feel like all of our plans have been put on hold—or stolen from us indefinitely. But it’s important to hold close the fact that we have options. Fertility preservation is a path that can provide hope and healing. Our fears tend to grow in the dark. So, this Mother’s Day, let’s celebrate the light with hope, information and empowered understanding. 

“Sometimes the strength of motherhood is greater than natural laws.” – Barbara Kingsolver

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