Protecting your fertility when you have breast cancer

When starting treatment for breast cancer, many people worry about losing the ability to have children. But one promising treatment could dramatically lower the chances of infertility in certain people with breast cancer: treatment with gonadotropin-releasing hormone agonist (GnRHa) medications.

A 2022 meta-analysis of 11 different randomized trials published in the journal Menopause looked at 1,219 premenopausal people undergoing chemotherapy for breast cancer. Researchers found that adding GnRHa to chemotherapy improved the chance of returning to normal ovarian function after therapy by 22.8 percent, compared to chemotherapy without it.

The overall impact on fertility is not clear based on the results of the meta-analysis, with improvements seen in women with hormone-receptor negative breast cancer, but not in others. Despite this limitation, the study showed that treatment with GnRHa holds promise as an option for people with breast cancer.

How GnRHa works

In addition to attacking cancer cells, chemotherapy can destroy the eggs in ovaries and cause menopause to start early, leading to infertility. It also increases the risk of osteoporosis, heart disease, and other health issues. 

GnRHa, which is given in regular injections at a healthcare provider’s (HCP’s) office, temporarily reduces blood flow to the ovaries and puts them in a resting state. Essentially, this means the drug shuts down the ovaries’ activity, making them less vulnerable to chemotherapy. 

Other breast cancer treatments, such as radiation and surgery, generally don’t affect fertility unless the ovaries are removed.

Know your fertility options

Experts say GnRHa should be used with other methods to preserve fertility. If you’ve been diagnosed with breast cancer and want to have a child, here are some other options to consider:

• Embryo cryopreservation: During this process, eggs are harvested from the ovaries, fertilized through in vitro fertilization (IVF), and implanted when the person is ready to get pregnant. While this method has the highest chance of success, it’s expensive and sperm must be made available immediately to fertilize the egg.
• Egg freezing: Similar to embryo freezing, unfertilized eggs are frozen and then stored.
• Ovarian cryopreservation: This experimental option involves removing, freezing, and storing all or part of an ovary. The tissue then can be placed back in the body later. In some cases, researchers have even implanted it in an arm. 
• Ovarian transposition: This procedure involves surgically repositioning the ovaries within the pelvis, moving them out of the area where radiation will be applied. The ovaries might need to be repositioned again after therapy to conceive.

Regardless of the method you choose, many HCPs advise cancer survivors to wait two years before attempting to get pregnant. That’s because the risk of relapse is greatest in the first two years. But everyone’s risk is different, so work with your HCP if you’re planning to conceive.