Q: I am 35 years old. I was recently diagnosed with breast cancer and will be undergoing chemotherapy, radiotherapy and hormone therapy.
I am single but I plan to start a family. How does each cancer treatment affect a woman's fertility? When can I start planning for children and what are my chances of conceiving?
A: While surgery and radiotherapy have little effect on fertility, chemotherapy can definitely harm the ovaries and the ovarian reserve.
This can affect fertility adversely.
Chemotherapy is the use of drugs to kill cancer cells. However, it also kills some healthy cells. By damaging the cells in the ovaries responsible for forming eggs, chemotherapy can cause premature ovarian failure or early menopause.
Cyclophosphamide -- an often-prescribed chemotherapy drug for treating breast cancer -- is quite harmful to the ovaries.
Age is also an important factor to consider. At 35 years, fertility is already declining.
In addition, it is usually prudent to wait a few years after breast cancer treatment before getting pregnant. This is because the majority of breast cancer cases are hormone-sensitive, so pregnancy will increase the risk of the cancer returning.
Given these factors, after waiting a few years, and especially after chemotherapy, the ovarian reserve will most likely be diminished.
As the primary concern of the surgeons and oncologists treating cancer patients is to cure the patients of the disease, fertility issues can sometimes be neglected.
If you are concerned about your fertility, you should highlight it to your surgeon or oncologist.
The surgeon can then refer you to a fertility specialist who would discuss various methods of fertility preservation with you.
The oncologist can also use chemotherapy treatments that are less damaging to the ovaries.
There are various ways to preserve your fertility, such as by freezing your ovarian tissue. A wedge of ovarian tissue can be removed in a minimally invasive laparoscopic operation before you start your chemotherapy.
The tissue is then frozen and preserved.
If the chemotherapy causes you to have premature ovarian failure, the preserved ovarian tissue can then be implanted to achieve pregnancy.
You can also freeze your eggs or embryos. This is a time-tested and reliable method.
However, as you are not married yet, only freezing or cryopreservation of eggs is applicable to you.
In this method, in the short time that you have before the start of chemotherapy, you need to undergo stimulation of your ovaries to get them to produce many eggs, which will be extracted and frozen.
Cryopreservation with a new method called vitrification is more effective and more successful.
Later, when your disease is cured and when you decide to start a family, the eggs can then be thawed and fertilised with your spouse's sperm.
While the likelihood of getting pregnant will be affected by chemotherapy, the above methods can help to maximise your chances.
As long as the doctors involved have a fertility-preserving mindset and are willing to employ the appropriate modern technology, fertility is possible despite cancer.
DR LOH SEONG FEEI,medical director of Thomson Fertility Centre
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