Preservation of Fertility and the Impact of Subsequent Pregnancy in Patients With Premenopausal Breast Cancer

The occurrence of early-stage breast cancer in premenopausal women who desire children is a considerable clinical challenge. The frequent use of adjuvant cytotoxic chemotherapy can induce ovarian failure and infertility, while the frequent use of adjuvant hormonal therapy is a contraindication to conception. A variety of techniques to preserve fertility in spite of adjuvant chemotherapy are under investigation, with promising early results. Ovarian stimulation with retrieval of eggs for in vitro fertilization and cryopreservation prior to the commencement of chemotherapy seems to hold the greatest promise for patients. There is no evidence that patients treated with curative intent for early-stage breast cancer who subsequently become pregnant have a compromised survival, but patients should be counseled regarding their risk of recurrence in general and whether a high recurrence risk might make subsequent pregnancy and motherhood an unwise choice. The offspring of breast cancer survivors do not appear to suffer deleterious consequences as a result of the diagnosis or treatment of the mother.