Can You Have Kids After Breast Cancer?

Does a breast cancer diagnosis have to change your plans for a family? Not necessarily — but you may have to do a bit more planning than you’d originally expected.

“Understanding how cancer may affect your fertility is important because you have options,” says cancer specialist Erin Roesch, MD. “But some options are only available before treatment starts. Whether you know you want children or are still undecided, talk to your healthcare provider as soon as possible after diagnosis.”

Can breast cancer affect fertility?

Any cancer can impact fertility. Cancer treatments can damage your reproductive system. They can also shorten the window of time you have for becoming pregnant. But many people can and do become pregnant after breast cancer.

Breast cancer treatments that affect fertility include:

Chemotherapy

Chemotherapy can damage your eggs and reduce ovarian function. And it’s common for your menstrual cycle to stop during treatment. Whether it comes back depends on your age and the chemotherapy type, dose and duration.

So, can you get pregnant after chemotherapy?

The honest answer is: It depends. And you can’t make assumptions: Your period returning doesn’t necessarily mean fertility has returned. That’s why Dr. Roesch recommends consulting with a fertility specialist before starting chemo — and returning after treatment to determine whether your fertility status has changed.

Hormone therapy

Estrogen is a hormone that stimulates the growth of some breast cancers. Hormone therapy prevents cancer cell growth by:

• Blocking estrogen production
• Preventing estrogen from linking to cancer cells

Like chemotherapy, hormone therapy disrupts menstruation. These effects are usually temporary, but they can be permanent.

Ovary removal

Some people with breast cancer have BRCA or other genes that increase their risk for other cancers, such as ovarian cancer. If you have a breast cancer gene, you may opt to have surgery to remove your ovaries. This surgery affects your ability to become pregnant.

“Ovary removal can also be a component of hormone therapy for people with hormone-positive breast cancer, as this leads to surgical menopause,” explains Dr. Roesch.

FAQs about having a baby after breast cancer

Dr. Roesch answers some common questions about fertility and pregnancy after breast cancer.

Is it safe to have a baby after breast cancer?

It’s natural to worry about safety if you decide to have a baby after treatment. Overall, the risks are low. Many people have successful pregnancies after cancer treatment.

Will pregnancy cause the cancer to come back?

Research has found that pregnancy does not increase the chance that cancer will return. “In fact, many studies show reassuring outcomes across all different types of breast cancer,” says Dr. Roesch.

Is there a risk to my baby?

There’s no evidence that babies born to breast cancer survivors have a higher chance of birth defects or long-term health problems.

One exception to this is if you pass a breast cancer gene to your baby. Having the gene increases their risk of breast and other cancers. If this is a concern for you, talk to a genetic counselor. They can help you understand the hereditary risks.

What about pregnancy complications?

Breast cancer treatment is linked to a higher risk of pregnancy complications, including:

• Cesarean section
• Low birth weight
• Preterm birth

A Swedish study found that the risk of complications only went up in pregnancies conceived within two years after treatment. Pregnancies conceived more than two years after treatment had no increased risks.

How long should I wait after breast cancer treatment to become pregnant?

In general, most providers advise waiting two years. This time allows your body to heal.

Talking to your healthcare team can be helpful for deciding how long to wait to get pregnant. Factors they’ll encourage you to consider include:

• The type of cancer you had
• The risk of cancer returning
• Your age
• Your personal pregnancy goals

For hormone-positive breast cancer, providers recommend hormone therapy for five to 10 years following treatment. But it’s not a hard-and-fast rule, and this may occupy a time window that women think about starting or growing families.

“Clinical trials show you don’t need to wait the full five or 10 years to become pregnant,” clarifies Dr. Roesch. “It’s safe to take a break after at least 18 months of hormone therapy to attempt pregnancy. You should then resume treatment after your baby is born. Importantly, this approach should be discussed with your doctor to see if it is an option that may be considered.”

Should I use contraception during and after breast cancer treatment?

Planning a pregnancy can be a challenge for breast cancer survivors. And there are definitely times when you need to avoid getting pregnant, including:

• During treatment. Chemotherapy and hormonal therapy aren’t safe for a developing fetus. There’s a small chance that you could get pregnant during treatment, so it’s very important to use contraception during that time.
• After treatment. It’s best to avoid pregnancy until your provider gives you the green light.

Talk to your provider about your options for birth control. Nonhormonal birth control methods are usually recommended for women with a history of breast cancer.

Can I breastfeed after breast cancer?

You may be able to breastfeed after breast cancer, depending on the kind of treatment you had. For example, surgery removes breast tissue, while radiation therapy can damage it. Both treatments can affect milk production and flow.

“If you had surgery or radiation therapy on one side, breastfeeding is still possible from the other breast, provided no other cancer treatment is being given,” says Dr. Roesch. “Talking to a lactation consultant before delivery can help you get a good start and anticipate any problems that might arise.”

Chemotherapy can also affect your ability to produce milk. Don’t breastfeed while receiving chemotherapy and hormone therapy. These medications can enter breast milk and harm your baby.

Options for parenthood after breast cancer

Fertility preservation offers a range of strategies to help you have a baby after breast cancer. The most common strategies are egg freezing and embryo freezing, shares Dr. Roesch. Both involve removing eggs from your ovaries before cancer treatment. The eggs can be frozen alone or fertilized to create an embryo, which is then frozen.

Medications called gonadotropin-releasing hormone (GnRH) agonists can also protect your ovaries during chemotherapy. Your provider may include these medications in your treatment plan.

In some cases, you may not be able to use your own eggs or carry a baby after treatment. That doesn’t mean you can’t become a parent. Donor eggs, surrogacy and adoption are all options for parenthood after breast cancer.

When to talk to a fertility specialist

Your provider may not ask you about your plans for having children when planning breast cancer treatment.

“It’s important to be aware of how fertility can be affected by cancer and treatment. You can always raise the issue with your provider if they don’t bring it up,” encourages Dr. Roesch. “I also recommend asking for a referral to a reproductive endocrinology and infertility (REI) specialist.”

REI specialists have expertise in fertility preservation. They can help you explore your options for becoming pregnant after cancer treatment. Once you become pregnant, an REI specialist can also work with your Ob/Gyn to help you have a healthy pregnancy.