Fertility preservation in breast cancer
Where do we begin... you must be reading these lines quite soon after you've found your diagnosis, and here's our first tip – DO NOT PANIC!
Get a grip, calm down, breathe, and we will get pull through together.
Breast cancer is the most common cancer among women, and the trend in recent years has been diagnosing it in younger patients.
These days, however, breast cancer is curable, and our goal is to return you to your normal life. To achieve this, we often have a long way to go, which involves various combinations of surgery, radiation, chemotherapy, hormone therapy, and target therapy.
Unfortunately, effective therapy often comes with unwanted side effects. While modern oncological science has been largely successful in dealing with unpleasant acute adverse events, such as nausea and vomiting, the ovaries are another very important organ that is sometimes not addressed properly in the shock following the diagnosis.
Therapies we use today can affect the ovaries and cause them to stop functioning, which we call premature ovarian failure.
Other than the unpleasant consequences of early menopause, this also leads to infertility, which is a particular problem in younger patients.
We are lucky to have a simple, affordable and SAFE solution – storing eggs, embryos, or ovarian tissue before starting active treatment.
Frequently asked questions and common situations you may run into
I am going to have preoperative (neoadjuvant)/postoperative (adjuvant) chemotherapy. When is the right time to contact you?
In both cases, the recommendation is to preserve your reproductive cells before starting therapy. As mentioned, this takes 10-12 days, and will not delay the proper treatment in any way. This time is often used for additional staging procedures.
No pre- or post-operative chemotherapy has been planned for me. In that case, does it even make sense to freeze eggs?
The answer is ‘yes’, and you should talk to us both prior to and after your surgery.
If chemotherapy is not indicated for you, it is likely that you have what is called a hormone-sensitive breast cancer, where hormone therapy is a mandatory component of a successful treatment. Hormone therapy is, however, teratogenic (can cause harm to the fetus if pregnancy occurs while on treatment).
Nowadays, hormone therapy most often lasts for 5-10 years, which means that after it is done, you are very likely going to be in the 37-40 years age group. At this age, the possibility of spontaneous pregnancy decreases considerably, because of the natural decrease in ovarian reserve with advancing age.
Which therapies would have the most adverse effect on my ovarian reserve?
How much will your ovaries be affected also depends on your age (see table on the left). Even if the risk of a particular chemotherapy regimen is low, it is almost never 0%.
In addition, during the course of therapy, some medications may need to be switched for your own good, and this may have a negative effect on your reproductive ability.
Which is better, eggs or embryos?
The matter should be discussed with the reproductive specialist. Even with married partners, eggs are the more common option, because frozen embryos are unusable in the event of a change of partner. However, embryo freezing is also an option.
How will I use them after I have recovered?
The eggs will be thawed at the right time, then they will be fertilized in vitro, then at a precise moment one or two of the developing embryos will be placed in the uterus.
More information about this is available HERE.
What is this procedure's success rate?
Success depends on both your age and the number of eggs stored.
As an example, if you are aged 36 years and up, and you have 15 stored eggs, the chance of giving birth to a child using those eggs is about 70%. Thinking you have a real chance without stimulation and with 1 frozen egg only is delusional. That chance really is very low.
What will happen if I don’t succeed in getting pregnant with the frozen eggs?
If your ovaries are still working, we can try new stimulation to extract more eggs, despite the fact that their quality has deteriorated. In recent years, studies have shown that this type of stimulation is also safe.
If this does not work, or if your ovaries have stopped working completely, a good option remains to get pregnant with a donor egg.
Is there any point to this if I am 40 or older?
The answer is a resounding yes. Despite reduced odds, our opinion is that trying is always worth it. We store eggs from women with breast cancer up to the age of 45. This is a chance you should take! If government funding is not available because of your age, the consultation, exams, stimulation and the procedure itself will be free to you! The only cost will be the stimulation medications.
If I am not sexually active, can I preserve eggs?
Yes, this is something we have done repeatedly. In these cases, a brief surgical intervention is required to remove part of the hymenal ring to allow the ultrasound probe to enter. The procedure takes minutes and is performed under anesthesia.
What if my therapist is against fertility preservation?
Unfortunately, this is still a rather common occurrence, but we hope we could change it, starting with this website. We believe we have managed to convince you that this is a globally established practice, and in Bulgaria we are very fortunate that the state is funding it. This is not a reason to change your therapist, but you can always seek a second opinion. We can help with that!
Remember that...
You should seek advice NOW!
Every woman with breast cancer at reproductive age should consult a reproductive specialist, regardless of the stage of her disease and whether she has given birth previously or not. This is also the official recommendation of the most reputable medical oncology and reproductive medicine organizations, such as ESMO, ASCO, and ESHRE.
This will not delay your therapy in any way.
Your consultation with our reproductive specialists will be done within 24 hours of your call, no matter where you are in the country. If you choose to preserve your fertility we can begin immediately, where the day of your menstrual cycle is of no consequence, and will complete the procedure in about 10 days. There is an exceptional coordination between the reproductive specialists and medical oncologists in Nadezhda Hospital, allowing the planned treatment to begin immediately after successful egg retrieval.
The safety of this procedure is proven; it does not impair the cancer outcome prognosis in any way, whether it is a hormone-sensitive breast cancer or not. Subsequent pregnancy is also proven safe when discussed and coordinated with the treating medical oncologist.
Fertility preservation options
In current practice, the following procedures are used to preserve fertility in breast cancer:
| Fertility preservation options | Frequency of application and success rate of the approach | |
| Egg/ embryo freezing | ★★★ | |
| Ovarian tissue freezing | ★ |
★★★ - most commonly used approach, highest success rate ★★ - less frequently used approach, lower success rate ★ - rarely used approach
