Breast cancer and fertility preservation modalities

Abstract

Carcinoma of the breast is on constant rise even in developing countries. Adjuvant chemotherapy specially with alkylating agents such as cyclophosphamide is gonadotoxic and markedly accelerates the rate of depletion of ovarian follicles. Even women who regain menses after cytotoxic chemotherapy antihormonal therapy are likely to have undergone significant follicle depletion and reproductive aging of 10 years or more. Although loss of fertility is an important issue for young cancer survivors, there is often little or no discussion about fertility preservation before initiation of adjuvant therapy. Infertility specialists should aim for greater familiarity with prognosis and effects of different types of adjuvant therapy for carcinoma breast. Fertility preservation options such cryopreservation of embryos, oocytes, and ovarian tissue on the part of oncologists should be discussed with the suffering woman. With reduction in mortality from breast cancer, fertility preservation has become a major issue for young women developing breast cancer. Every young woman who is likely to undergo gonadotoxic cancer treatment should be counselled about the effects of therapy and options available to her to increase the likelihood of childbearing after cancer treatment.