Fertility Preservation in Patients with Breast Cancer

Many breast cancer treatments are gonadotoxic, which can result in infertility in survivors. Patients should be counseled on the impact of cancer treatment on future fertility and their options regarding fertility preservation. The main purpose of this narrative review is to discuss the implications of breast cancer treatment on future fertility and review various strategies for fertility preservation and their safety in this population.

There is no demonstrated effect of ovarian stimulation, GnRH agonist therapy, or ovarian tissue cryopreservation/transplantation on breast cancer outcomes. In regard to oocyte/embryo cryopreservation, women should be counseled on equivalent fertilization and pregnancy outcomes with frozen and fresh oocytes/embryos. To prevent delaying the start of neoadjuvant chemotherapy, “random start” protocols can be used and are equally effective as conventional protocols. After breast cancer treatment, women should be counseled on equivalent disease outcomes for those who become pregnant vs. those who do not, including those who interrupt adjuvant endocrine therapy to carry pregnancies.

Fertility preservation should be discussed and offered to reproductive-aged patients with breast cancer, which has demonstrated safety in this population.