1. Will breast cancer treatment affect my fertility?
2. Referral to a fertility clinic
3. Fertility in women
4. How breast cancer treatments can affect fertility
5. Options for preserving fertility
6. Contraception during and after breast cancer treatment
7. Useful organisations
8. Further support

1. Will breast cancer treatment affect my fertility?

Some treatments for breast cancer, such as chemotherapy, can affect your ability to become pregnant.

Having breast cancer treatment may mean you have to think about your fertility sooner than you had planned. While your main concern is probably treating your breast cancer, if having children of your own is important to you then procedures to preserve your fertility – such as IVF or freezing eggs – can be offered.  

It’s important to talk to your treatment team about this before your breast cancer treatment begins.

Men who are treated for breast cancer may want to discuss fertility preservation options with their treatment team.

You may also want to download or order our booklet Fertility, pregnancy and breast cancer.

On our page about Options for preserving fertility before and during breast cancer treatment you can watch videos about people's experiences of this.

 

2. Referral to a fertility clinic

If having children in the future is important to you, your treatment team should offer a referral to a fertility specialist to discuss the option of preserving your fertility. This should be done as soon as possible after diagnosis to prevent any delays in your treatment.

Find out what happens at a fertility clinic » 

Questions to ask

  • Can I check if I’m fertile before my breast cancer treatment starts?
  • How will my age affect my fertility?
  • What are my chances of getting pregnant after treatment?
  • How long after treatment will I have to wait to find out if I’m still fertile?
  • How can I try to preserve my fertility?
  • Will I be able to have fertility treatment on the NHS (including embryo or egg storage)? If not, how much will it cost?
  • What does fertility treatment involve?
  • How successful are the different methods of preserving fertility?
  • Can I use a sperm donor?

If you’d like to see a fertility specialist and this has not been offered, ask your specialist or breast care nurse as soon as possible after your diagnosis to reduce any possible delays to your treatment. You can ask to be referred to a fertility clinic that has experience in helping women having cancer treatment.

For a list of fertility clinics in the UK, see the Human Fertilisation and Embryology Authority (HFEA) website.

NICE guidelines

NICE (National Institute for Health and Care Excellence) guidelines for assessing and treating people with fertility issues recommend that women with breast cancer should:

  • Have the chance to discuss the impact of cancer and its treatment on future fertility with their cancer team at the time of diagnosis
  • Be offered appropriate procedures to preserve fertility if their breast cancer treatment may lead to loss of fertility, as long as they’re well enough to have the procedures, it will not worsen their condition and there’s enough time before cancer treatment begins

The usual conditions for deciding whether someone can have fertility treatment should not apply to people with cancer.

NICE guidance only applies to England. Assessment and treatment may be different in Wales, Scotland or Northern Ireland, your treatment team can tell you more about this.

 

3. Fertility in women

To understand how breast cancer treatments might affect fertility, it can be useful to know some basic facts about fertility in women.

Women are born with a set number of eggs in their ovaries (you do not produce new ones). By the time a woman reaches puberty, the number of eggs she has will have already decreased, and the number continues to decrease as she gets older. Generally, the quality of the eggs also reduces as a woman ages, which can affect fertility.

Every month, a woman’s ovaries release at least one egg. Pregnancy occurs if an egg is fertilised by a man’s sperm and implants itself in the womb. If an egg is not fertilised, you have a period.

The ovaries stop releasing eggs, and monthly periods stop, when a woman reaches the menopause around the age of 51, though studies show that women with an altered breast cancer gene (BRCA) will experience an earlier menopause.

 

graph showing fertility decline

Source: mskcc.org

 

4. How breast cancer treatments can affect fertility

Can chemotherapy cause infertility?

Chemotherapy can cause infertility in women who have not been through the menopause (pre-menopausal). It can affect the functioning of the ovaries, reducing the number and quality of eggs.

The likelihood of you having fertility problems in the future depends on the type of drugs used, the dose given, your age and what your fertility was like before breast cancer treatment. You can usually take time to consider your options for preserving fertility before starting treatment. If you want to have children in the future, discuss this with your breast cancer team.

The chemotherapy drugs most likely to affect your fertility are a group called ‘alkylating agents’. One of these (cyclophosphamide) is commonly used in combination with other chemotherapy drugs to treat breast cancer.

The effect of some other chemotherapy drugs, such as taxanes (docetaxel and paclitaxel), on fertility has not been as widely studied, but evidence suggests they’ll also affect fertility.

Chemotherapy can cause your periods to stop. This may be temporary or permanent. In general the younger you are when having treatment, and particularly if you’re under 35, the more likely it is that your periods will return. Women over 35 are more likely to lose their fertility after chemotherapy.

It’s possible to stop having periods temporarily during treatment and to start having them again later, months or occasionally even a few years after treatment has finished.

Even if your periods return after chemotherapy, the menopause is likely to happen sooner (up to 5–10 years earlier) than it would have done if you had not had chemotherapy. This may mean you have a shorter time to try to get pregnant.

If your periods do return, it does not always mean you’ll be able to get pregnant, so it’s important to speak to your treatment team if you have any concerns.

Can you become pregnant while taking hormone therapy?

Hormone therapies are used in women whose breast cancer is oestrogen receptor positive (ER+).

Some of the most commonly used hormone therapy drugs for pre-menopausal women with breast cancer are:

In most pre-menopausal women who take tamoxifen, the ovaries continue to work. When you start taking tamoxifen it may stimulate ovulation (release of the egg from the ovary) and could make you more fertile. However, getting pregnant on tamoxifen is not recommended.

For some women, continued use of tamoxifen means periods become less regular, lighter or stop altogether. Generally, your periods will start again once you stop taking tamoxifen, as long as you have not gone through the menopause naturally while taking the drug. However, it may take four to five months for your periods to become regular again.

Goserelin switches off the production of oestrogen from the ovaries. It’s often combined with other hormone therapies used to treat breast cancer, such as tamoxifen or aromatase inhibitors.

Hormone treatment is usually taken for five years or longer. While you’re taking hormone treatment you’ll be advised not to get pregnant as it may harm a developing baby. Even if your periods stop while you’re taking hormone therapy you could still get pregnant.

Due to the length of time it’s taken for, the side effects of hormone therapy may hide the signs of a natural menopause. It may only be when you finish taking it that you realise you’ve started or been through the menopause.

If you want to have children and you’re in your 30s or early 40s, taking hormone therapy for five years or more may be an issue you want to discuss with your treatment team.

Removal of the ovaries (oophorectomy)

Some women may have their ovaries removed as part of their breast cancer treatment, or as risk-reducing treatment if they have an altered gene. If you have had this operation you'll be left infertile, but can consider egg or embryo donation in the future. See our information on surgery to remove the ovaries.

 

5. Options for preserving fertility

Several procedures to preserve your fertility may be available to you before you start your breast cancer treatment.

Find out about your options for preserving fertility »

 

6. Contraception during and after breast cancer treatment

Women are advised to avoid getting pregnant while having breast cancer treatment, as the treatment can damage an unborn baby at the early stages of development.

If you’re sexually active with a man, your specialist is likely to advise using a non-hormonal contraception, such as condoms, female condoms (Femidoms) or a diaphragm.

It may also be possible to use a coil (IUD or intrauterine device). Speak to your treatment team as not all types are suitable for women with breast cancer. The contraceptive pill is not advised after a diagnosis of breast cancer as it contains hormones.

The morning-after pill can be used in an emergency as it’s a single dose of hormones and unlikely to affect your breast cancer.

You should use reliable contraception during treatment. After treatment your decisions about contraception will depend on how you feel about getting pregnant.

Find out more about planning pregnancy after breast cancer treatment.


7. Useful organisations

British Infertility Counselling Association

bica.net

A charity providing counselling and support to people affected by infertility. You can also find a counsellor in your area.

Daisy Network

daisynetwork.org.uk

Voluntary nationwide support group for women who experience a premature menopause. Allows members to share information about their personal experience of premature menopause.

Fertility Friends

fertilityfriends.co.uk

An online community discussing infertility, adoption, parenting after infertility and moving on.

Fertility Network UK

fertilitynetworkuk.org

Provides support and information, and promotes awareness of fertility issues. Also incorporates More to Life, a national charity providing support to people who are involuntarily childless.

Save My Fertility  

savemyfertility.org

An American patient information resource provided by the Oncofertility Consortium.


8. Further support

Whatever your feelings, you do not 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.

You can also call our free Helpline on 0808 800 6000 to talk to one of our trained nurses.

Last reviewed: November 2019
Next planned review begins 2021

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