Fertility Preservation Before Breast Cancer Treatment

Fertility preservation before treatment is an option for women who want to protect their ability to have genetically related children in the future. There are a number of options to consider, though each has its pros and cons.

Embryo Freezing

Involves using a woman’s own eggs and the sperm of a male partner or donor.

• Ovaries are stimulated to produce multiple eggs in a single cycle, and those eggs are harvested through an outpatient surgical procedure.
• The eggs are fertilized in the lab with sperm (“In Vitro Fertilization” or “IVF”), then frozen and stored.
• The entire process takes between two and six weeks. Recent research shows that ovarian stimulation and the resulting hormonal changes do not adversely affect cancer recurrence risk. In particular, there is no increased cancer recurrence risk as a result of aromatase inhibitor-supplemented ovarian stimulation protocols, which are now well established and commonly used for breast cancer patients.

To achieve a pregnancy:

• Frozen embryos are thawed and implanted into the woman’s uterus or that of a gestational carrier (surrogate) who will carry the fetus.
• To reduce the chance of multiple births, usually no more than two embryos are implanted during any one cycle.
• Hundreds of thousands of babies have been born from frozen embryos.

Since egg or embryo freezing may be timed with the start of your period, your cycle may dictate the amount of time needed for these processes. If you are having chemotherapy before surgery (neoadjuvant treatment), talk with your doctor about whether it is possible to delay treatment to complete embryo freezing.

Egg Freezing

Women who do not have a male partner or do not want to use donated sperm may choose to freeze eggs over embryos.

• Like embryo freezing, egg freezing begins by stimulating the ovaries to produce multiple eggs in a single cycle, and harvesting those eggs.
• The entire process takes between two and six weeks and may start at the beginning of a woman’s period.

To achieve a pregnancy:

• The eggs are thawed and fertilized with sperm (in vitro) and implanted into the woman’s uterus or that of a gestational carrier.
• Modern vitrification techniques have dramatically improved egg freezing outcomes. Recent studies show that with current technology, more than 90% of frozen eggs survive the thawing process, and egg freezing success rates are now comparable to or even exceed those of frozen embryos for many patients. Studies have shown live birth rates of 35-70% depending on age at freezing and number of eggs thawed, with the best outcomes when eggs are frozen before age 35 and when 20 or more mature eggs are thawed
• Well over 100,000 babies have been born from the use of frozen eggs worldwide.

Ovarian Tissue Freezing

GnRH agonists may protect your fertility while you undergo treatment, though they should not be used in place of established fertility preservation methods.

• Ovarian tissue is removed in a surgical procedure, then frozen and stored. When a woman is ready to become pregnant, the strips will be re-implanted.
• The tissue is meant to produce hormones so eggs will begin to mature again.
• Women whose treatment includes ovarian suppression will not be able to re-implant the ovarian tissue until after that treatment is completed.
• Over 200 babies have been born from the use of frozen ovarian tissue worldwide, and research shows that perinatal outcomes are comparable to the general pregnant population.

Ovarian Suppression

Ovarian suppression is an experimental option that may protect your fertility while you undergo treatment.

• It is possible to suppress your ovaries during treatment with monthly shots (such as goserelin/Zoladex or leuprolide/Lupron). GnRH agonists may be offered as an adjunct to established fertility preservation methods in females with breast cancer.
• Recent research showed that GnRH agonists during chemotherapy may improve the likelihood of preserved ovarian function and pregnancy. Among breast cancer patients treated with GnRH agonists during chemotherapy, 10.3% experienced post-treatment pregnancies compared to 5.5% treated with chemotherapy alone.Ask your doctor if this is an option for you.

Learn about your options for motherhood after breast cancer treatment.