When Victoria Raphael was diagnosed with breast cancer at 33, she was in “total shock” — which makes perfect sense. At 33, she certainly didn’t fit the profile of a typical breast cancer patient. Raphael didn’t immediately think about the need to consider fertility preservation ahead of treatment, but, as she quickly learned, that’s something many young breast cancer patients need to think about (on top of the realities of facing the disease, of course). 

“The fact that my fertility might be affected [by treatments for breast cancer did not cross my mind at all,” she tells Rescripted.

While we know that breast cancer is common (one in eight women will be diagnosed in their lifetime), people typically think of it as a disease that almost exclusively affects women over 50, people who have already had their children (or chosen to remain child-free). Because of that, we don’t talk enough about how breast cancer treatments might affect a person’s reproductive potential down the line, which leaves women like Raphael shocked when they learn all the ways breast cancer treatment can compromise a person’s ability to carry a pregnancy.

But, according to the CDC, 9 percent of new breast cancer cases are in women under age 45. 

Of course, time is of the essence, and getting treated is of utmost urgency — but for young patients who still want to build their families after a breast cancer diagnosis, there’s one thing they may want to do before beginning treatment: Preserve their fertility via egg or embryo freezing.

How can breast cancer treatment affect fertility?

“Common breast cancer treatments, such as chemotherapy, can impact reproductive tissue and lead to infertility,” says Jaime Knopman, MD, Director of Fertility Preservation at CCRM New York. “Hormone therapy can impact the cadence of a cycle and impact the hormone levels that can impact fertility. It is often contraindicated to try and conceive while on hormone therapy and therefore the delay in time can impact fertility. Surgery may remove reproductive organs. Radiation to the pelvis will cause premature ovarian failure and induce menopause (among other side effects)."

Dr. Knopman, a breast cancer survivor herself, is also the Chief Medical Officer at Chick Mission, a non-profit that provides grants to help people undergo fertility preservation ahead of cancer treatments. 

Like Raphael, who tells Rescripted she was “completely overwhelmed and unfamiliar” with the fertility options she could pursue to allow her to build her family after cancer treatments, many people may be totally unaware of how cancer treatments can affect fertility. “That’s why it’s important to discuss options for fertility preservation before starting cancer treatment,” says Dr. Knopman.

Physicians should ask breast cancer patients if they’re looking to grow their families and make them aware of their options after a breast cancer diagnosis. As for options, “embryo freezing is the most widely available and most standard practice,” says Dr. Knopman. 

Of course, for someone facing a cancer diagnosis, treatment is of greatest urgency, and people may be afraid to hesitate in order to undergo the process of embryo freezing. “Timing is extremely critical and our physicians at CCRM can expedite the process of freezing eggs or embryos (fertilized eggs) so that cancer treatment is not delayed,” says Dr. Knopman. 

Not everyone will freeze eggs or embryos before treatment, and there are also options for people post-treatment. 

“If you weren’t able to do fertility preservation before cancer treatment and are now having difficulties getting pregnant, there are still options available to you such as fertility drugs or IVF,” says Dr. Knopman. “If a woman’s ovarian function is diminished as a result of chemotherapy or radiation, she may have the option of embryo transfer using donor eggs. During this procedure, a known or anonymous donor contributes eggs to be combined with a partner’s sperm. The fertilized embryo is then transferred into the patient’s uterus in an attempt at pregnancy."

Guidance is key during this process. A cancer diagnosis is, after all, a lot to process even before you factor in fertility preservation. Patients deserve experts who can hold their hands and guide them through their options. 

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“Dr. Knopman at CCRM Fertility made sure I understood my options, supported me [from] start to finish on my unique fertility journey,” says Raphael. “When I was officially cancer-free she helped us embark [on] our surrogacy journey and referred me [to another physician], where we successfully transferred our healthiest embryo and were pregnant with our baby boy soon after. My husband and I are embarking on the journey again for baby number two.”

Of course, part of individualizing care comes down to what type of family you want down the line. For some breast cancer patients, having to make those decisions while also processing a diagnosis just amounts to unthinkable emotional overwhelm. 

“No matter your age, a breast cancer diagnosis can be life-altering, with tunnel vision on starting treatment right away,” says Dr. Knopman. “While not everyone who is diagnosed with breast cancer knows if they will want children, a discussion of fertility preservation with a fertility expert will allow for a woman to make an educated and informed decision about family-building options.”

As for Raphael’s advice for women who find themselves facing a breast cancer diagnosis while also considering family-building, here’s what she had to say:

“Advocate for yourself, ask questions, and communicate with your support system your family planning goals so they can help guide you through an overwhelming time,” she says. “Your oncologist will know exactly how long you can prolong treatment to family-plan through fertility preservation. Your fertility doctor will guide you through the best process for you based on your cancer type and timing for treatment.”

Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.