Chemo and Fertility

[Bexley103]

Let me begin by apologizing if this question has been previously posted, but I can find no record of my situation in the archives.

I am 34 years old, diagnosed with breast cancer at the end of August, had a simple mastectomy in September, and am due to begin chemo in mid-November. So far I have spoken to 3 oncologists about a chemo plan. Not surprisingly, each doctor has a different plan and reads my surgical pathology report differently. My concern regarding chemo is the issue of fertility, and once again, each doctor has a different response. Here are the plans I have been given:

#1: Unsure of what drugs but told that I would receive a standard treatment of 2-3-4 (2 drugs, 3 times, every 4 weeks). This doctor offered to arrange an appointment with a fertility clinic, and would offer to give me Lupron to halt ovary production. No tamoxifen.
#2: My treatment would be Adriamycin/cyclophosphamide every 2 weeks for 2 months, followed by Taxol every week for 3 months. I felt my questions about fertility were essentially ignored. I was told Lupron was a possibility if I took tamoxifen following chemo (which he says is a possibility).
#3: My treatment would be Adriamycin/cyclophosphamide every 2 weeks for 2 months, followed by Taxol every week for 3 months. I would also have the opportunity to participate in a clinical trial with Bevacizumab. I might be able to receive injections of Zoladex. Probably no tamoxifen.

Has anyone out there been in this predicament? I am very confused and overwhelmed by all of this information. I feel that due to my age, I am in a gray area regarding my chances of remaining in menopause after treatments. Does anyone have any advice?

[Irishgal2]

Hi,

Very tough time for you and so many decisions to make.  I was 39 when diagnoised last year and had 4 cycles of AC chemo, followed by radiotherapy and now Tamoxifen for 5 years.

I continued to have a period during chemo, but at the end of my chemo, the blood test showed I was in menopause status, but could not tell if it was permanent of not.  2 months later I did another blood test and was back ovulating.  My periods continued and even now that I am on tamoxifen.  Zoladex and Lupron as far as I know shut down the ovary function, so these drugs would stop you getting pregnant.  I was warned about betting pregnant on Tamoxifen so I got the copper coil inserted as a contraceptive.

What I was told is that the closer you are to your natural menopausal age when you have chemo, the greater the chance of going into permanent menopause.  The good news is that you are only in your 30's, so that is in your favour.

The best of luck to you

[lhughes]

There is a support group called PregnantwithCancer.org that might have some answers or advice to the questions you are raising.  

I was 36 at diagnosis for Stage III, ER+.  I am currently on Tamoxifen for a VERY long time and had to have my tubes tied.  Pregnancy is usually not recommended if you are ER+, however, some women have gone on to have successful pregnancies.

I had A/C and Abraxane (Taxol like drug) as my chemo and can honestly say that none of those drugs messed with my ovulation.  I would be concerned with the use of Lupron since I have read that some women have issues getting pregnant after using this drug.  I would also be concerned with the "no tamoxifen, maybe tamoxifen"...  Tamoxifen should not be used for BC if you intend to get pregnant, it can have serious complications for a fetus.  Strangely enough, though, this drug is used to stimulate the ovaries and can be used as a fertility aid before ovulation.

My recommendation would be to pin your oncologist on what is planned for treatment, take that information to a Reproductive Endocrinologist and let them advise you from that perspective based on you and your forthcoming treatment.  

Good luck in all this.

[PaulMD]

Hi there.

Indeed, the treatment of cancer is not uniform accross the cancer centers, and each can have different protocols regarding specific cancer treatment.  However, with what you have posted, I believe that all of your options are sound and valid and should give you a good survival and recurrence free benefit.

Regarding your concern on fertility, chemotherapy drugs indeed causes depression of your ovaries which can cause transient amenorrhea and anovulation (unable to ovulate).  Your ovulation should resume after the chemotherapy, but this is likely to be hindered by hormonal treatment such as Zoladex or Lupron (getting pregnant is very hard at this point and is also contra-indicated).

Cyclophosphamide can also carry the risk of permanent sterility (as high as 20% in some studies) and you should be aware of this possibility.

Planning your pregnancy will really take a good physician-patient relationship and you should also be aware of the consequences of withdrawing the hormonal treatment just to get pregnant.

Regards and God bless.