Preserving Fertility Before Breast Cancer Treatment

A breast cancer diagnosis can make it tough enough to plan for the week ahead, let alone the years to come.

But addressing your pregnancy and fertility goals is an important part of creating your treatment plan. And whatever you decide, your future self will thank you for considering it.

Reproductive endocrinologist Mindy Christianson, MD, explains your options for fertility preservation and breast cancer treatment.

How breast cancer treatment can affect fertility

For some people, breast cancer treatments lower your chances of conceiving only temporarily. For others, treatments may make it so they can’t get pregnant without intervention.

“Cancer treatment can impact fertility in many ways,” Dr. Christianson says. “It depends on factors like which treatments you had, how old you are and where you are in your reproductive life.”

She explains a few ways breast cancer treatments affect fertility.

• Ovarian damage: Age and chemotherapy can deplete your egg supply. You’re born with a set number of eggs that decrease in number and quality with age. Chemo can further decrease your supply. The effect can vary depending on your age and the type of chemo drugs used.
• Early menopause: Hormone therapy and ovarian suppression, used for hormone receptor-positive breast cancer (HR+), causes a temporary state of menopause. These treatments can last 10 years and prevent childbearing during that treatment period.
• Sperm quality: Chemotherapy, hormone therapy and radiation can damage sperm and lower your fertility.

Newer treatments, like immunotherapy and biologics, haven’t been around long enough for healthcare providers to fully understand how they may impact fertility. So, if those treatments are recommended as part of your plan, fertility preservation will likely be a part of the conversation, too.

Fertility preservation options before treatment

If you’re interested in preserving your fertility before starting cancer treatment, there are several options. The best choice for you will depend on your sex, age, diagnosis, treatment timeline and personal goals.

“There isn’t a one-size-fits-all approach,” Dr. Christianson explains. “When I meet with people with breast cancer, we talk through their family-building goals and their treatment plan together.”

Your fertility preservation options may include:

• Freezing your eggs: Treatments stimulate your ovaries to produce multiple eggs, which are retrieved and frozen for future use. If you decide to use your eggs in the future, a provider will fertilize them with sperm from a partner or donor and implant the embryos.
• Freezing embryos: Your eggs will be retrieved the same way as they would be for egg freezing, but the eggs are first fertilized (using a partner’s or donor’s sperm) and then frozen.
• Freezing ovarian tissue: This is a less common procedure where a surgeon removes and freezes your ovary or tissue from your ovary. It can be transplanted back into your body after completing cancer treatment. That can allow you to conceive on your own.
• Sperm banking: Sperm are frozen and stored for future use. This is the most common fertility preservation option for men.

Is it safe to preserve fertility before treatment?

Timing is a common concern about fertility preservation. For example, it typically takes about two weeks to stimulate your ovaries and retrieve eggs for egg or embryo freezing.

Squeezing in those procedures before you begin cancer treatment can feel like putting the immediate cancer concern on the back burner. But in most cases, you have some time for fertility preservation measures before you begin other treatments.

“It’s ideal to do fertility preservation before starting chemotherapy whenever possible,” Dr. Christianson encourages. “It’s an option more often than you may think.”

But, you may be wondering, what about the procedures themselves? Before freezing eggs or embryos, providers purposefully raise your estrogen levels to make egg retrieval possible. And some breast cancers use estrogen to grow.

Your team will take that into account throughout your fertility preservation treatment. There are specific medication protocols designed to keep your estrogen exposure as low as possible. And your team will work closely together to lower the risk.

“It’s a coordinated effort,” Dr. Christianson explains. “We’re all focused on making sure cancer care remains the top priority.”

What if fertility preservation before treatment isn’t possible?

Not everyone has the time or opportunity to preserve their fertility before treatment.

You may have needed to start breast cancer treatment quickly. You may not have thought you wanted to have kids in the future and then changed your mind. Or real-world barriers, like insurance coverage or access to fertility specialists, got in the way.

But there’s still hope.

After cancer treatment, specialists can evaluate your fertility with blood tests and imaging to understand your chances of conceiving. Some people are able to get pregnant naturally after breast cancer treatments. Others can benefit from fertility treatments like IVF or surrogacy.

“There are many ways to build a family,” Dr. Christianson reassures. “What matters is understanding your options.”

The takeaway: You deserve information — and support

Fertility concerns are a valid part of cancer care, and they deserve space alongside the rest of your treatment decisions. Early conversations can help you feel more informed and more in control during an overwhelming time.

“If fertility is important to you, talk to your doctor and bring it up,” Dr. Christianson says. “And even if you aren’t planning to conceive anytime soon, or aren’t sure you ever want children, having a fertility consultation can help you understand your choices.”

There are options. There is support. And there can be a life — and a family — after breast cancer.