Options for preserving fertility before and during treatment

If you want to discuss ways of trying to preserve your fertility, talk to your treatment team and fertility specialist before your breast cancer treatment begins.

Some women choose not to have a family. Others prefer to wait and see. And some people choose to have fertility preservation in the hope of having children, or more children, in the future.

Your options include:

1. No fertility preservation
2. Freezing – a method of preserving eggs, embryos or ovarian tissue before starting cancer treatment
3. Ovarian suppression – a method of protecting the ovaries during chemotherapy

Fertility preservation is not always successful and there’s no guarantee it will end with pregnancy.

Before you start breast cancer treatment, you’ll need to decide if you want to try to preserve your fertility. It can be difficult to decide what options are best for you and making a decision might feel overwhelming. 

Not all younger women having breast cancer treatment will have fertility problems in the future.

Some women know what they want to do, while others have a harder time making a decision. Your religious or moral beliefs may also affect your decision making about fertility preservation.

It’s important to choose what’s right for you.

Your treatment team should offer you a referral to a fertility specialist to discuss the option of preserving your fertility. This should be as soon as possible after diagnosis to prevent any delays in your treatment.

Talking to a fertility specialist about your options can help you come to a decision. It might also help to talk it through with your breast care nurse, treatment team, partner (if you have one), family or friends.

There’s also a decision aid called Cancer, Fertility and Me which can help you think about the options.

If you wish to explore the option of having fertility preservation, you should have access to counselling support at your fertility centre.

Some people may consider not having chemotherapy if they’re concerned about their fertility. Talk to your treatment team about the benefits of having chemotherapy and the effects that different chemotherapy regimes may have on your fertility.

You may decide you don’t want to have children or more children if you already have any. Or you may prefer to wait to see if your fertility returns when your treatment is over.

Fertility naturally declines with age. The closer you are to the menopause, the higher the chance that your cancer treatment will affect your ability to conceive naturally.

Your treatment team or fertility specialist can advise you about your specific circumstances and monitor your fertility after treatment.

None of the methods for preserving fertility can guarantee you’ll get pregnant and have a baby after breast cancer treatment. However, ongoing research is leading to improvements in the success rates of procedures currently available.

Not all the freezing procedures described below are available in every fertility clinic, and success rates vary.

You can check the fertility preservation procedures your local fertility clinic offers on the HFEA website.

You may not be eligible for fertility treatment on the NHS and there may be costs involved. See “Will I have to pay for fertility treatment?” below.

Stimulating the ovaries to produce more eggs

Fertility preservation involves taking drugs and having daily injections to boost your egg production and help the eggs mature. This is known as ovarian stimulation. Collecting more eggs will increase the chances of pregnancy in the future.

Ovarian stimulation usually takes about 2 weeks, so it occasionally delays the start of chemotherapy. However, newer fertility practices mean that preservation can be started at any time during a woman’s menstrual cycle (called a “random start”), and chemotherapy can usually go ahead as planned or with a very short delay.

You’ll need to give yourself daily injections of hormones for about 10 to 12 days to help your ovaries produce more eggs than normal. You’ll be taught how to do this. During this time, you’ll have a type of scan that involves placing a probe inside the vagina (transvaginal ultrasound scan) and blood tests to check your ovaries.

The hormone injections increase the amount of oestrogen in your body. Some women worry about the effect this might have on their breast cancer. Initial studies have shown that ovarian stimulation does not seem to affect the growth of breast cancer cells, but more research is needed before this can be proven.

Using breast cancer drugs, such as letrozole or tamoxifen, alongside hormone injections increases the number of eggs produced and lowers the level of oestrogen in the body during fertility treatment.

About 34 to 38 hours before your eggs are due to be collected, you’ll have a final hormone injection to help mature your eggs.

Egg collection

Once ovarian stimulation is complete – and if it’s successful – your eggs can be collected and frozen.

When the eggs are ready, they’ll be collected with a fine needle passed through the wall of the vagina up to the ovaries. This is done under sedation or general anaesthetic.

Egg freezing

There are various reasons why you may choose egg freezing as an option. For example, you may not currently have a partner. You may prefer not to use donor sperm. Or it may not be possible to create an embryo for other reasons.

Frozen eggs can be stored for many years. When the time is right for you, they can then be thawed and fertilised with sperm before being implanted in the womb.

Find out more about freezing and storing eggs on the HFEA website

Embryo freezing – in vitro fertilisation (IVF)

IVF involves removing eggs from your ovaries and fertilising them with sperm in a laboratory to create embryos.

Not all eggs fertilise, and it’s important to recognise that only some embryos will develop into a pregnancy.

Some people in relationships choose to store eggs as well as embryos to keep options available for the future. If you wish to consider egg freezing and embryo freezing, talk to your fertility team as it may not be possible to have both.

If you’re single or in a same-sex relationship, you may choose to use donor sperm. Your fertility specialist can talk to you about this and give advice on finding a suitable donor.

The organisations listed under “Useful organisations” further down can provide more information about sperm donors.

Once embryos are created, they legally belong to both you and your partner or sperm donor. You’ll both need to give consent to store and use any embryos. If any party then withdraws their consent in the future, you’ll not be able to use the embryos and they’ll be destroyed.

Your embryos can be frozen and stored for up to 55 years. However, you and your partner or donor will need to renew consent every 10 years to keep them. 

Find out more about IVF and using donated sperm on the HFEA website.

Ovarian tissue freezing

If you need to start your breast cancer treatment and don’t have time to freeze embryos or eggs, this could be an option for you.

Ovarian tissue is removed and frozen before cancer treatment starts.

When treatment has finished, the tissue can be thawed and re-implanted so that the ovary starts functioning again.

If you have an altered BRCA1 or BRCA2 gene, this option is not available because of the higher risk of developing ovarian cancer.

Ovarian tissue freezing is newer than other techniques and is not as widely available. Talk to your treatment team if this is something you’d like to consider.

Pre-implantation genetic diagnosis (PGD)

If you have an altered gene that increases breast cancer risk and are worried about passing this on to your children, you may want to talk to your genetic counsellor about the possibility of pre-implantation genetic diagnosis (PGD).

This involves going through an IVF cycle and checking the embryos for the inherited altered gene before freezing them. Only the embryos that are not affected by the altered breast cancer gene are then stored.

This procedure is only offered in some fertility clinics.

For more information about inherited breast cancer, see our family history webpages.

You may want to ask your fertility specialist about the risks of each fertility preservation option.

Many children have been born from stored eggs and embryos and there does not seem to be any health risk to the child.

We do not know yet if there is any risk with ovarian tissue freezing as this is a newer technique. But fertility specialists believe any risk is likely to be very small.

Currently there is no evidence that fertility preservation increases the risk of breast cancer coming back, but research in this area is ongoing.

Some studies have shown that using hormone therapy drugs like goserelin (Zoladex) to suppress the ovaries may protect them during chemotherapy. This is because goserelin temporarily “shuts down” the ovaries by stopping them from producing the hormone oestrogen, which means your periods will stop.

Ovarian suppression involves monthly injections with a hormone therapy like goserelin (Zoladex). This starts before chemotherapy and continues throughout your chemotherapy treatment.

If you’re having goserelin to try to preserve fertility, you will usually have an injection of goserelin before chemotherapy starts, then every 4 weeks during chemotherapy. The last injection is after the final chemotherapy treatment.

However, we don’t know how effective goserelin is as a method of preserving fertility. It cannot replace other methods such as egg and embryo freezing.

It’s natural to feel anxious before attending your first clinic appointment. If you have a partner, you can bring them along with you. You could also bring a friend or family member for support.

You’ll be able to ask questions and discuss the different fertility preservation options, the likely success of fertility treatments, what the procedures involve, the risks and available counselling.

If you’re currently taking the oral contraceptive pill, you’ll be asked to stop this. However, it’s still important to use barrier methods of contraception, such as condoms or female condoms (Femidoms).

If you decide to go ahead with fertility preservation, you’ll need to have some tests. These include blood tests for HIV, hepatitis and to check your hormone levels, and a transvaginal ultrasound scan.

If you’re hoping to freeze embryos, your partner or sperm donor will also need to have blood tests and give a sperm sample.

The results of all these tests will help the fertility team decide which fertility options may be suitable for you.

NHS funding may be available, but the amount of funding and the criteria for treatment may depend on:

• Where you live
• If either you or your partner already have children
• Your age

If you’re not entitled to NHS-funded treatment, you may want to fund the treatment yourself. It may also be possible for you and your fertility specialist to apply for “exceptional funding” if you do not meet the funding criteria.

Even if NHS funding is available for the initial fertility preservation, it doesn’t guarantee that funding will be available to cover storage and using the frozen material in the future to try for a pregnancy.

If you have private health insurance, check whether your cover includes fertility treatment. Paying for treatment privately may also be an option.

Talk to your fertility specialist about potential financial costs before starting any fertility treatments.

Donor Conception Network

dcnetwork.org

A supportive network for donor conception families.

Human Fertilisation and Embryology Authority (HFEA)

hfea.gov.uk

This organisation monitors and licenses all IVF clinics in the UK. It produces a list of centres providing IVF and leaflets on IVF, egg donation and egg freezing.

Whatever your feelings, you don’t have to cope alone. You may find it helpful to share your thoughts with another person whose fertility has been affected by breast cancer treatment.

• Our Someone Like Me service can put you in touch with someone who’s had a similar experience to you – see below
• Chat to other people with breast cancer on our online forum
• Meet other women at one of our Younger Women Together support events – see below

You can also call our free helpline (below) to talk to one of our specialist nurses.