Coping With Pregnancy and Cancer
- A resilient mother diagnosed with triple-negative breast cancer at 33 had to undergo cancer treatment – chemotherapy and a lumpectomy – while pregnant. She managed to give birth to a healthy “miracle” baby and reach remission.
- Breast cancer and a clogged duct can have similar symptoms, including the development of a lump in the breasts. Moms who discover a lump, swelling, or nipple discharge should contact their doctor to screen for breast cancer.
- Triple-negative breast cancer can be more aggressive but is typically more sensitive to chemotherapy treatment, which means that there is a high chance that the treatment will kill all the cancer cells.
- Various cancer treatments, including chemotherapy and radiation, can affect both men’s and women’s fertility. Before undergoing cancer treatment, patients should speak to their doctors about fertility preservation if they wish to have a family in the future.
Cancer can impact the fertility of women and men, but options exist to help people battling cancer achieve their dreams of raising beautiful, healthy children.
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Helping Patients With Fertility Resources
A few months later, in September 2020, Stephanie learned her lump was actually related to cancer. She was diagnosed with triple-negative breast cancer at just 33 years old. She admitted she was stunned by the surprise diagnosis.
“It was really surreal because I don’t have any history of breast cancer in my family,” Stephanie said.
Triple Negative Breast Cancer
Triple-negative breast cancer is an aggressive form of breast cancer that does not have any of the main drivers of breast cancer, which include the estrogen receptor, the progesterone receptor, and the HER2 receptor. Because triple-negative breast cancer doesn’t contain those receptors, it does not respond to treatments that target them.
“Any triple-negative cancer that’s over half a centimeter or has lymph node involvement needs chemotherapy,” Dr. Julie Nangia, medical oncologist at Baylor College of Medicine, said.
“This is usually two different types of chemotherapy for three months, each with two different classes of drugs: taxanes and anthracyclines,” Dr. Nangia added.
Other types of breast cancers include hormone-receptor-positive, which needs either estrogen and/or progesterone to grow, and HER2-positive breast cancer, where high levels of the HER2 protein can be found on the outside of the cancer cells.
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Stephanie’s Treatment
Stephanie said she first underwent a lumpectomy to treat her cancer while pregnant.
A lumpectomy is surgery to remove cancer or abnormal tissue from the breast. It’s also known as breast-conserving surgery because, unlike mastectomy, only the tumor and some surrounding tissues are removed.
WATCH: What’s the recovery process like after a lumpectomy?
“A lumpectomy is typically about an hour, depending on the type of procedure that the patient needs,” Mount Sinai Health System breast surgeon Dr. Sarah Cate tells SurvivorNet.
“Really, all that you remember from the surgery is just going to sleep after the IV goes in. As the breast surgeon, I then make a cut in the breast and remove the cancer, and then I will do certain plastic surgery techniques to rearrange the tissue just in that area to make it look nice. A lot of the time, the stitches are underneath the skin, and I use skin glue,” Dr. Cate added.
During her second trimester, Stephanie started chemotherapy for her triple-negative breast cancer. The type of chemo most likely involves Anthracycline and taxane (a class of chemotherapy drugs), as Dr. Nangia noted. These chemo drugs have become a mainstay for breast cancer treatment. However, despite the effectiveness of these chemotherapy drugs, they come with intense side effects such as nausea, vomiting, and alopecia (hair loss). Fortunately, your doctor may have been able to offer some relief.
“Chemotherapy that we give currently is not the chemotherapy from days gone by,” says Dr. Matthew Carlson, a gynecologic oncologist at UT Southwestern Medical Center. Patients are not vomiting and stuck in bed for weeks on end or coming into the hospital.”
Stephanie gave birth to Leo in April of 2021. She calls him a miracle baby.
For Stephanie’s husband, Evan, he calls his wife a “strong and beautiful woman.”
“I take my inspiration from her, seeing her go through this, you know, cancer pregnancy pandemic, you know, at the same time. She did that, and, you know, there were tough times, no doubt. But, you know, she persevered, and that’s what’s so amazing about her,” Evan said.
Stephanie says she is now “cancer-free” and undergoes regular scans every six months.
Cancer Treatment’s Impact on Fertility in Women
Just as cancer treatment can impact men’s fertility, women may also be affected. Some types of chemotherapy can destroy eggs in your ovaries. This can make it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the drug type and age since your egg supply decreases with age.
WATCH: Fertility after Cancer
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you have a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women preserve their fertility before cancer treatment by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor specializing in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment immediately and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- For women getting radiation to the pelvis, Ovarian transposition moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine therapy.
Questions for Your Doctor
If you’re wondering how your cancer treatment may affect your fertility and what options are available to you, consider asking your doctor these questions, according to the National Cancer Institute:
- Could my treatment lead to infertility?
- Are there other recommended cancer treatments that might not cause fertility problems?
- Which fertility preservation options would you advise for me?
- What fertility preservation options are available at this hospital? At a fertility clinic?
- Would you recommend a fertility specialist (such as a reproductive endocrinologist) I could talk with to learn more?
- What are the chances that my fertility will return after treatment?
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