Does Breast Cancer Treatment Affect Fertility?

Written in collaboration with Tanya Franklin, MD, MSPH, FACOG

When a woman is diagnosed with breast cancer, there are many concerns and uncertainties that may come up. What treatment is right for me? What are the side effects and how will they make me feel? What does the future hold?

For young women diagnosed with breast cancer, there may be an additional concern: Will breast cancer or treatment affect my future fertility? The incidence rate of breast cancer in young women is low, with about 10% of new breast cancer cases diagnosed in women under 45. Though the incidence is low, many of these women may be looking to start or expand their families when they are diagnosed.

We recently spoke with fertility expert and OBGYN Tanya Franklin, MD, MSPH, FACOG, who answered our most-asked questions about how breast cancer and breast cancer treatment may affect a woman’s future fertility and ability to conceive.

---

Question: Does breast cancer cause infertility?

Answer: Breast cancer itself does not cause infertility. When a diagnosis of breast cancer is given, many characteristics of that breast cancer determine the chance of it impacting future fertility. These characteristics include the type of breast cancer, the stage of breast cancer, and the treatment options chosen.

---

Q: Does breast cancer treatment cause infertility?

A: The short answer is that some breast cancer treatments can lead to infertility, depending on what type of treatment is received. Women are born with 1-2 million eggs in their ovaries. Although we typically mature one egg and release (ovulate) it each month for a chance at pregnancy, we also lose 1,000 immature eggs every month naturally. As we age, we know our fertility decreases, with the average age of menopause (when menstruation stops and women can no longer become pregnant) being 51 years old. The type of cancer that is diagnosed and the type of treatment chosen to treat it will determine if that fertility timeline is changed. 

---

Q: How do different breast cancer treatments affect a woman’s fertility?

A: Advancements in breast cancer treatment options have made tremendous strides, and today there are many options to treat breast cancer. Some treatment options will not impact fertility, while other options can impact fertility in different ways. 

• Breast cancer surgery: Surgery to treat breast cancer, usually in the form of a lumpectomy or a mastectomy, should not affect a woman’s fertility. If breast cancer is diagnosed at an early stage, surgery may be the only treatment needed. Your doctor will help you decide if surgery is a good option for treating the type and stage of breast cancer you have.
• Chemotherapy: Chemotherapy may have a temporary or permanent impact on fertility. Because chemo drugs can damage the ovaries and speed up the ovarian aging process, it can lead to premature menopause before the age of 51. When the ovaries reduce the number of eggs released, or stop releasing eggs (ovulating) altogether, such as in menopause, fertility is impacted and a woman may not be able to conceive naturally.
• Hormonal therapy: Many women will receive hormonal therapy as part of their treatment for breast cancer. Hormonal therapies such as aromatase inhibitors (AIs) are commonly used to treat hormone receptor-positive (HR+) breast cancers. Estrogen is needed to have functional ovaries that ovulate or release eggs, but AIs block the estrogen that fuels HR+ breast cancer growth. While this effect is not usually permanent, hormonal therapy medications are typically prescribed to be taken for at least 5 years, which could be during a woman’s most fertile years.
• Radiation therapy: Radiation uses high-energy rays to destroy cancer cells. If targeted only at the breasts, radiation should not impact the ovaries in the pelvis and, therefore, should not cause fertility issues.
• Bilateral oophorectomy: A bilateral oophorectomy is a surgery to remove the ovaries. Women with a genetic component to their breast cancer, such as a breast cancer gene mutation, may be advised to have their ovaries removed. Removing the ovaries will permanently impact fertility; once the ovaries are removed, ovulation ceases.

---

Q: Does breast cancer or breast cancer treatment cause menopause? What can be done to prepare for this?

A: Breast cancer itself does not cause menopause. However, certain treatments for breast cancer can induce early or premature menopause. In some instances, this menopausal state can be reversible.

There are many mental, social, and physical ways you can prepare for menopause, including:

• Educate yourself about the symptoms of menopause so you can feel prepared and not be taken by surprise. Symptoms of menopause may include menstrual changes, hot flashes, sleep disturbances, mood changes, and more.
• Exercise regularly and eat a healthy, balanced diet rich in vitamin D, calcium, and protein. These things can help support healthy muscles and bone health. A healthy diet and exercise can also positively impact your mental health.
• Manage your stress with relaxation techniques like yoga, meditation, and mindfulness. Stress management is an important coping skill that can help reduce the stress hormones in your body, leading to overall mental well-being and support of your body’s immune system.
• Consider taking supplements to support things that are important to you. Vitamin B can help fight fatigue. Omega-3 can help with brain function and may reduce the risk of Alzheimer’s and dementia. Zinc and selenium are antioxidants that support the immune system, while turmeric helps reduce inflammation. There are many other supplements that may be recommended for women diagnosed with breast cancer. Be sure to discuss all supplements with your care team before taking them.
• Remember that just because you are menopausal does not mean you are defined by it. Take care of yourself and give yourself the grace to ease into this hormonal transition.

---

Q: What are the options for preserving fertility before, during, or after breast cancer treatment?

A: When you are diagnosed with breast cancer, you may feel overwhelmed. You will be speaking with doctors about treatment options, self-care, and how your diagnosis will impact your life moving forward. Many women are taken by surprise when they also have to consider their fertility, when it may not have been at the forefront of their lives at the time of diagnosis.

Early conversations about fertility desires are important to help reduce the overwhelm you may feel with a new diagnosis. Support from a partner and family is also crucial to determine if future fertility is a priority in your overall care. Fertility is an important topic to discuss because there are options to preserve your future childbearing, if that is a desire. It is also an opportunity to plan for your future after treatment is completed. If your doctors don’t mention fertility preservation options before your treatment is set to start, don’t hesitate to bring the topic up yourself.

If you wish to preserve your fertility before breast cancer treatment begins, your doctors will refer you to a fertility specialist to discuss all options. Some options to preserve fertility include:

• Egg freezing: Also known as oocyte (egg) cryopreservation, this medical procedure involves stimulating, retrieving, freezing, and storing mature eggs (oocytes) for later use in in vitro fertilization (IVF). If you already have a partner, the oocytes can be fertilized. The fertilized embryos would then be frozen and stored to be used for future IVF procedures. If you choose to freeze your eggs before treatment begins, the process should be expedited so as not to delay breast cancer treatment for too long.
• Gonadotropin-releasing hormone (GnRH) analogs: During breast cancer treatment, medications called gonadotropin-releasing hormone (GnRH) analogs can be given before or during chemotherapy to temporarily suppress ovarian function and protect the ovaries for future fertility. 

Building a family after breast cancer treatment can happen through many options. If fertility or the ability to carry a child cannot be preserved through treatment, many women may choose to obtain donor oocytes (eggs) for IVF, have a surrogate carry a pregnancy, or pursue adoption.

---

Q: Does in vitro fertilization (IVF) increase the risk of developing breast cancer or breast cancer recurrence?

A: Studies have shown no significant increase in breast cancer risk or recurrence risk in women who underwent IVF treatments when compared to women who did not undergo IVF treatments.

---

Q: What questions should I ask my doctor about my fertility before I begin treatment for breast cancer?

A: Knowledge is power and empowers you to make the best decisions for yourself and your family. Questions to ask your care team about fertility before beginning treatment may sound like:

• The hormones of pregnancy are estrogen and progesterone. If my breast cancer is estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), or both (ER+/PR+), can I try for pregnancy after treatment? Do you recommend against future pregnancy?
• Does future pregnancy put me at risk of breast cancer recurrence?
• How soon can I try for pregnancy after treatment is complete?
• Should I be on a birth control method during my treatment?
• What are my birth control options during treatment?
• Will there be damage to my eggs (oocytes) from chemotherapy or other medications I must take for treatment?
• Is there a risk to the baby if I get pregnant after treatment?
• What are the risks to pregnancy after breast cancer treatment?

---

Support for young women diagnosed with breast cancer

A breast cancer diagnosis often causes a wide range of emotions, including fear, sadness, worry, and even anger. Young women whose future fertility may be impacted by breast cancer treatment need additional support from family, spouses or partners, friends, and loved ones.

Support groups are a good way for women to seek out the help and support they need from others facing a similar situation. NBCF offers free support groups for breast cancer patients and survivors. Additionally, the Young Survival Coalition offers support groups tailored to younger women who may be facing fertility issues due to breast cancer treatment.

National Breast Cancer Foundation is here for you as you navigate a breast cancer diagnosis. Visit our website to learn about NBCF breast cancer support groups, obtain free educational resources, or find a patient navigator in your area.

The information provided in this article should serve as a general guide and should not be used for the diagnosis or treatment of a medical condition. Always discuss aspects of your health, treatment, and fertility with your individual care team.

---

References:

American College of Obstetricians and Gynecologists (ACOG). “Female Age-Related Fertility Decline”. Committee Opinion Number 589. March 2014.

American College Of Obstetricians and Gynecologists (ACOG). FAQs: Breast Cancer Survivorship: Health and Fertility After Treatment.  https://www.acog.org/womens-health/faqs/breast-cancer-survivorship-health-and-fertility-after-treatment

American Society for Reproductive Medicine. “Fertility Drugs and Cancer: A Guideline (2024)”.  https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-drugs-and-cancer-a-guideline-2024/#:~:text=A%20large%20cohort%20study%20evaluated,%E2%80%931.36)%20(83)

Healthline https://www.healthline.com/health/breast-cancer/vitamins-supplements

U.S. Centers for Disease Control & Prevention https://www.cdc.gov/bring-your-brave/breast-cancer-in-young-women/

---