Breast cancer and the de­sire to have children

The pur­pose of che­mo­the­rapy is to stop the rapid growth of tu­mour cells. These cells are per­ma­nently da­maged th­rough the ap­pli­ca­tion of che­mo­the­ra­peu­ti­cals . Ho­wever, the da­mage cannot be li­mited to only tumor cells but also ex­tends to he­althy tis­sues. For ex­ample, in the area of the fe­male re­pro­duc­tive or­gans, ova­rian tissue can also be per­ma­nently af­fected. In con­se­quence, the fe­male cy­clus can be per­sis­t­ently trans­formed. The risk of not even ha­ving a pe­riod after chemo is up to 68 per­cent.

So how can one’s fer­ti­lity be pre­served after cancer the­rapy? That is the cru­cial ques­tion. In order to answer it, many dif­fe­rent fac­tors need to be ex­amined:

• Is the tu­mour hor­mone-de­pen­dent or hor­mone-in­de­pen­dent?
• What cancer tre­at­ment is being con­sidered?
• How old is the pa­tient?
• What is the si­tua­tion re­gar­ding the wo­man’s ova­rian re­serve?

Most breast car­ci­nomas are hor­mone-de­pen­dent, i.e. the tu­mour-grow­this sti­mu­lated by the fe­male sex hor­mones oes­trogen or pro­ges­te­rone.

As a re­sult, a longer pe­riod of anti-hor­monal me­di­ca­tion is usually needed after sur­gery or che­mo­the­rapy. This re­duces fer­ti­lity. The­r­e­fore the de­sire to have children should be ex­pressed to your doctor be­fore starting cancer the­rapy.

There are a number of me­thods to en­sure that fer­ti­lity is pre­served be­fore cancer tre­at­ment. These are, for ex­ample Cryo­p­re­ser­va­tion of eggs. In this case, eggs are re­moved from the woman via a punc­ture to her ova­ries be­fore cancer tre­at­ment starts. These are then frozen in li­quid ni­trogen at minus 196 de­grees Cel­sius. Be­fore the — mostly un­fer­ti­lised — eggs can be re­moved, the ova­ries must be hor­mo­n­ally sti­mu­lated. After the cancer tre­at­ment has been suc­cessfully com­pleted, the eggs can then be thawed, ar­ti­fi­ci­ally fer­ti­lised via IVF and then rein­serted. Ac­cor­ding to ex­perts, the con­cern of pa­ti­ents with hor­mone-de­pen­dent breast cancer that ova­rian sti­mu­la­tion also in­duces the growth of tu­mour cells is usually un­founded.

Cryo­p­re­ser­va­tion of ova­rian tissue is also an es­tab­lished me­thod of pre­ser­ving fer­ti­lity no­wa­days. About half of an ovary is re­moved by la­pa­ro­scopy and frozen. It can then be re-trans­planted again at a later date.

It is also me­di­cally pos­sible to use GnRHa. This bulky ab­bre­via­tion stands for so-called go­na­do­tropin-re­leasing hor­mone ago­nists, which — ad­mi­nis­tered as a monthly or three-monthly in­jec­tion — put the ova­ries to “sleep” du­ring che­mo­the­rapy. This is to pro­tect the eggs by stop­ping them from ma­tu­ring which makes them less vul­nerable to che­mo­the­rapy. GnRHa is given be­fore che­mo­the­rapy be­gins and du­ring the rest of the tre­at­ment. After com­ple­tion of the che­mo­the­rapy, the idea is that the pa­ra­lysed ova­ries will re­turn to func­tional mode. Be­cause this me­thod has not yet been fully re­se­ar­ched, it is car­ried out in com­bi­na­tion with other fer­ti­lity-pre­ser­ving me­a­sures.

Cryo­p­re­ser­va­tion in par­ti­cular is a stan­dar­dized me­thod that has to be ma­naged fi­nan­ci­ally. Ho­wever, sta­tu­tory he­alth insu­rance com­pa­nies in Ger­many pay a pro­por­tion of the costs of fer­ti­lity pre­ser­va­tion me­a­sures for cancer pa­ti­ents. This in­cludes me­dical free­zing. The costs for the later, ne­ces­sary ar­ti­fi­cial in­se­mi­na­tion are also co­vered on a pro-rata basis. It is best to ask your own he­alth insu­rance com­pany as early as pos­sible to find out more.

Where can one turn for fur­ther in­for­ma­tion? Pa­ti­ents with breast cancer or other types of cancer who wish to have children should visit the Fer­ti­PRO­TEKT web­site. Here, gyneco­lo­gists and re­pro­duc­tive phy­si­cians from Ger­many, Aus­tria and Switz­er­land have joined forces to pro­vide women in par­ti­cular with ad­vice on fer­ti­lity-pre­ser­ving me­a­sures prior to che­mo­the­rapy. This gives the topic of the de­sire to have children a spe­cial status, espe­ci­ally in on­co­logy, which it did not have for de­cades be­cause of the focus on era­di­ca­ting cancer cells. A con­sul­ta­tion with a spe­cia­list is ad­vi­sable here.

The Fer­tiOnco page of the Uni­ver­sity Hos­pital Basel is also hel­pful in sel­ec­ting fer­ti­lity-pre­ser­ving me­a­sures. Here you will find more in­for­ma­tion on cancer and fer­ti­lity and, in par­ti­cular, an in­ter­ac­tive de­cision tool.

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.