Breast cancer treatments can significantly impact fertility through the direct effects of chemotherapy on the ovaries and delays in childbearing due to hormone therapy, and fertility counseling is recommended for all reproductive-age cancer patients. Standard preservation methods include oocyte and embryo cryopreservation, with emerging evidence for gonadotropin-releasing hormone (GnRH) agonists in reducing chemotherapy-induced ovarian insufficiency.
Concerns about future fertility are common among young women with breast cancer, with approximately one-third desiring children at diagnosis and half expressing some level of worry about infertility post-treatment. However, rates of fertility counseling vary widely, indicating gaps in addressing this concern effectively.
Safety data alleviate concerns about fertility preservation’s impact on cancer outcomes, with no delay in treatment initiation and no increased risk of recurrence associated with pregnancy after breast cancer. The study aimed to investigate fertility counseling rates, preservation technique usage, and the impact of fertility concerns on treatment decisions in a cohort of young breast cancer patients.
Participants diagnosed with breast cancer who were aged ≤50 years and had expressed interest in having children were surveyed between 2015 and 2020. Most reported concerns were regarding the potential for infertility to affect treatment decisions, correlating to a significant impact on the decision to select endocrine therapy duration. Nearly all participants recalled fertility discussions with their doctors before treatment, with almost half of participants taking steps to preserve fertility.
Embryo and oocyte cryopreservation were the most common preservation methods, with GnRH agonists increasingly used, especially in those diagnosed after 2018. However, uptake rates varied, with some patients relying solely on GnRH agonists.
The study’s strengths include high rates of fertility counseling and diverse preservation techniques. However, limitations include recall bias and a lack of racial diversity in the sample. The findings underscore the importance of addressing fertility concerns in young breast cancer patients and suggest the need for increased awareness and access to fertility preservation options.
Clinicians should routinely discuss fertility preservation with all premenopausal patients, irrespective of age, to ensure informed decision-making and facilitate reproductive options post-treatment.1
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