Fertility and Pregnancy after Breast Cancer
Young women with breast cancer may face the risk of becoming amenorrheic with treatment, either temporarily or permanently, resulting in potential infertility, onset of menopausal symptoms, problems with sexual functioning, and exposure to long-term risks of early menopause. The risk of amenorrhea is related to increasing patient age and treatment received (117,118) (Fig. 92.4). For some young women, cessation of menses may be welcome and may improve outcomes for women with HR-positive disease. For many young women, however, the threat or experience of infertility may be devastating. Discussion of this important survivorship issue should commence early in the treatment decision process because some women may elect to try to preserve fertility through intervention or forgo some therapy (119,120). However, available fertility preservation strategies including gonadotropin-releasing hormone (GnRH)-agonist treatment during chemotherapy, as well as cryopreservation of embryos, oocytes, or ovarian tissue are hampered by either limited efficacy, safety concerns, or both (121). Young breast cancer survivors can be reassured that at the present time no clear risk in having a biologic child exists. However, studies are limited by substantial biases, including the healthy mother bias, and concerns remain for some (122,123). Pregnancy after breast cancer is a very complex and personal decision for a woman who remains at risk for recurrent disease (for additional details, see Chapter 96 Reproductive Issues in Breast Cancer Survivors).
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