Getting pregnant after early breast cancer

Better breast cancer treatments are helping more women live longer. And, studies show pregnancy after breast cancer treatment doesn’t raise your risk of cancer returning or affect your survival.

While some women may become pregnant without fertility treatments after cancer treatment ends, assisted reproductive methods are enabling more women to have a child after treatment. Assisted reproductive technology can include storing eggs or embryos before cancer treatment, fertility treatments after cancer treatment, and use of donor eggs or embryos after cancer treatment.

Video: Pregnancy after early-stage breast cancer

Shehzin was diagnosed with early-stage breast cancer at age 27. She speaks about the decision to preserve embryos before treatment and working with her oncologist to pause hormonal therapy so that she could become pregnant.

Deciding whether to try to become pregnant after breast cancer treatment is a personal decision. It’s important to talk about your situation and options with your oncologist, a fertility specialist and your partner, if you have one. You may also want to talk with trusted family and friends.

This section is written for women treated for early-stage (stage I-III) breast cancer. Those diagnosed with metastatic disease (stage IV) will find information on our fertility and metastatic breast cancer page.

Protecting your fertility

Chemotherapy can damage a woman’s eggs. If you were premenopausal before treatment began, you may have chosen to store your eggs or embryos to protect, or preserve, your fertility. Fertility preservation involves helping your ovaries to make several or more eggs, called controlled ovarian stimulation, removing your eggs through surgery, and freezing them as eggs or embryos for later use.

Many young women do not have fertility preservation before treatment because:

• doctors don’t mention that breast cancer treatments can affect fertility or explain the options they have to protect it
• there are few or no fertility preservation services nearby
• they don’t have health insurance, their health insurance policy does not cover preservation, or they can’t afford to pay out-of-pocket for it
  • LIVESTRONG has a program to help women find affordable fertility services
  • Heart Beat Program helps women get fertility medicines
• they prefer to become pregnant naturally

If you haven’t had fertility preservation and are newly diagnosed, talk with your doctor about what options you have to protect your fertility. Some women who don’t have fertility preservation are able to become pregnant after breast cancer treatment, either naturally or through assisted reproductive technology.

Is pregnancy safe after treatment?

Research shows that

• pregnancy after treatment for early-stage breast cancer is safe for both the mother and fetus
• pregnancy does not increase the risk of recurrence or affect overall survival
  • This is still true if you have estrogen receptor-positive disease, breast cancer that needs estrogen to grow. Though estrogen levels rise during pregnancy, becoming pregnant after early-stage, estrogen receptor-positive breast cancer does not raise your risk of having the cancer come back

Always talk with your doctor about your individual situation and risk for recurrence. Other factors, like other unrelated health concerns or severe treatment side effects like heart damage, can impact the safety of pregnancy. Because treatment can sometimes damage the heart or lungs, your doctor should check them before you become pregnant.

Pregnancy and recurrence

Pregnancy increases levels of estrogen, a hormone that fuels some breast cancers to grow. This is why becoming pregnant was once thought to be unsafe for women after treatment. If they became pregnant, they were often advised to end the pregnancy by having an abortion.

Research has now followed large groups of women treated for early-stage breast cancer and tracked what happened if they got pregnant. The findings: those who became pregnant did not have a higher rate of recurrence or death from breast cancer than those who did not become pregnant after treatment.

A 2013 study found that among women with early-stage disease who became pregnant after breast cancer treatment and had an abortion, ending the pregnancy had no effect on recurrence or breast cancer-related death.

It is important to continue with follow-up cancer care throughout pregnancy and afterwards.

Timing tamoxifen and other therapy

Premenopausal women with ER-positive breast cancer are advised to take tamoxifen, a hormonal therapy, for 5 to 10 years after primary breast cancer treatment. This medicine lowers the risk of cancer returning.

Tamoxifen can harm a fetus, so you should not become pregnant while taking it. Trastuzumab (Herceptin), a treatment for HER2-positive breast cancer, also should not be taken while trying for a pregnancy, or when pregnant.

Doctors recognize that many women cannot wait up to 10 years before becoming pregnant. Waiting to the end of tamoxifen treatment might leave some women in menopause and unable to become pregnant. To avoid this, some doctors suggest taking tamoxifen for 2 or 3 years, to lessen risk some, and then taking a temporary break to try for a pregnancy. After pregnancy, the woman should start taking tamoxifen again.

If you are on an aromatase inhibitor (AI) instead of tamoxifen, similar recommendations apply.

According to Ann H. Partridge, MD, MPH, determining how long to be on tamoxifen before taking a break depends on

• your risk of recurrence
• how much your treatments lowered your risk for recurrence
• your desire to become pregnant sooner weighed against the benefits of longer tamoxifen therapy

Dr. Partridge, founder and director of the Program for Young Women with Breast Cancer at Dana-Farber Cancer Institute in Boston, is co-leading an international study of women who come off tamoxifen for a short time to become pregnant. The women are encouraged to resume therapy afterwards. The study is currently enrolling participants.

Wait 2 months for your body to clear tamoxifen before trying to become pregnant. After giving birth you should start taking tamoxifen again to complete the recommended treatment time.

Depending on your medical situation, it may be possible to delay the start of tamoxifen treatment in order to become pregnant or to go through the process of in vitro fertilization, or IVF. In IVF, an egg is removed from your body and fertilized in a test tube. The fertilized egg is then placed back in your womb where it continues to grow.

How long to wait before trying to get pregnant

Recent research has shown that waiting to try for a pregnancy for longer than 10 months after the end of chemotherapy does not increase recurrence risk or have a survival benefit. Other research has found that waiting only 6 months also did not increase risk.

Women trying to get pregnant naturally may be advised to wait 6 months after chemotherapy to allow time for damaged eggs to pass from the body.

Because the risk of recurrence in women treated for early-stage breast cancer is highest in the first two years after treatment, doctors may suggest waiting 2 to 3 years before getting pregnant.

Whatever time frame your doctor recommends, talk about why that length of time is being suggested and whether you will be taking tamoxifen or other medicine.

When pregnancy doesn't happen easily

Pregnancy rates are lower for women who have chemotherapy. It can take different lengths of time after chemotherapy for ovaries to recover. In younger women, recovery happens as early as 3 to 6 months after end of chemotherapy. However, even after 3 years of having no periods (a sign that the ovaries are not functioning), it is still possible to start having ovarian function again. The number and quality of remaining eggs will likely be lower due to treatment and due to getting older. This reduces fertility.

It may take several months of being off tamoxifen for ovaries to function again. For some women, that function might not return.

Egg reserve can be checked with a blood test to measure anti-Mullerian hormone (AMH) and a test to count ovarian follicles. Wait at least 6 months after finishing chemotherapy to do an AMH test. Because AMH tests change, it may be helpful to test again 12 months after finishing chemotherapy.

Fertility methods

You might want to try to get pregnant without medical help. Talk with your doctor about whether there are any medicines you should stop taking before trying.

If you didn’t see a fertility specialist or reproductive endocrinologist before breast cancer treatment, you may want to consult one afterwards. They can help you understand your options. You also may want to have your egg reserve tested.

Women treated for breast cancer can have ovarian stimulation to produce more eggs for natural conception, freezing or to create embryos for transfer into the uterus to attempt pregnancy.

• Research shows ovarian stimulation does not increase recurrence risk.
• The drug letrozole, used as hormonal therapy after breast cancer treatment, is used with fertility medicines to keep estrogen levels lower during this process.

If you had fertility preservation before chemotherapy and you want to plan for transferring eggs or embryos, talk with your fertility doctor.

Genetics and pregnancy

Women with a BRCA gene mutation who have not had cancer may have a lower egg reserve than women who do not have a mutation. After a breast cancer diagnosis and chemotherapy, BRCA-positive women are even more likely to have lower egg reserves. They may lose fertility more quickly than others treated for breast cancer.

In BRCA-positive women who have had breast cancer, assisted reproductive methods such as controlled ovarian stimulation and in vitro fertilization can be used.

For women concerned about passing on BRCA gene mutations to their children, embryos can be screened for disorders of the genes or chromosomes before they are put in the womb. This process is called pre-implantation genetic diagnosis. Women can choose to have only embryos that do not carry the mutation.

Other ways to build a family

For women who cannot get pregnant after treatment, there are other ways to become a parent.

• Surrogacy. Women who are medically unable to carry a pregnancy may choose to use a surrogate or gestational carrier. A surrogate or gestational carrier can be implanted with an embryo created through IVF. A gestational surrogate does not provide the egg. To date, there is no research that supports the need for women who have had breast cancer to use gestational carriers routinely.
• Egg donation. Women who no longer have viable eggs after chemotherapy may choose to use egg donation to build their families. An egg donor provides only the egg. After the egg becomes an embryo, the embryo is placed in the womb of the woman treated for breast cancer.

Consult a fertility specialist to learn about surrogacy and egg donation, their costs and any laws that may apply.

• Adoption. Babies and children are available for adoption in your home country or internationally. Costs vary widely.
  • Prospective adoptive parents in U.S. states submit medical histories as part of the adoption home study. Talk with your doctor about writing a letter describing your health and prognosis in everyday words.
  • Adoption may be private between individuals or facilitated through a public or private agency, or government office. Policies about applicants treated for cancer vary. Some require several years of disease-free health.
    • The Oncofertility Consortium at Northwestern University maintains a list of agencies open to prospective parents with cancer history.
  • Laws may pertain to home states or countries where the child is born and where the adoptive parents live. It’s important to have help from a lawyer specializing in adoption.
• Foster parenting. Children who are not yet legally available for adoption but have been removed from their homes may be placed in state foster care. Having had cancer treatment should not prevent you from becoming a foster parent. Many systems have foster-to-adopt programs if you want to adopt.