Breast cancer and fertility: an update

This review will summarize key fertility issues in young women with breast cancer. The detrimental effects of treatment modalities on ovarian and hormonal function will be reviewed. Options for fertility protection and preservation will also be outlined, as well as the unique issues facing women in pregnancy with a previous breast cancer diagnosis.

Gonadotropin-releasing hormone analogues continue to be in debate for their protective impact on the ovaries during the time of gonadotoxic treatment. Success rates in the cryopreservation of embryos, oocytes and gonadal tissue continue to improve. Concurrently, advancing reproductive technologies are developing promising techniques for obtaining mature oocytes from ovarian tissue and from early ovarian follicles. The pursuit of a pregnancy after breast cancer treatment is an additional challenge. Increasing bodies of evidence support the safety of pregnancy after breast cancer and the possibly improved survival. Still, there is an uncertainty regarding recommended intervals from diagnosis to conception. Preimplantation genetic diagnosis for hereditary breast cancer mutations is also becoming of increasing interest.

The fertility impact of breast cancer treatment in young women is of ongoing concern. The effects should be universally addressed and options should be outlined with young women prior to commencement of treatment.