Ask the Expert: Fertility After Breast Cancer

I recently had the opportunity to chat with Dr. Laxmi Kondapalli, a reproductive endocrinologist in Denver who specializes in oncofertility (i.e. helping cancer survivors with their fertility options).

As someone who had breast cancer before having any children, fertility concerns are high on my “things-to-worry-about” list. Am I still fertile? What if I’m not? Do I have options? What are they?

I figured if these questions were swimming through my brain, they likely were/are for many other young women as well. So I grabbed Dr. Kondapalli for a quick interview and she kindly agreed to share her wealth of knowledge with me, and all of you. Here’s what I found out:

Tamoxifen puts a cramp in fertility testing. Because of the effects of tamoxifen on messing with the brain’s signals (in order to prevent estrogen in the body), it’s difficult to accurately interpret the results of fertility tests. Dr. Kondapalli doesn’t recommend fertility testing to her patients who are taking tamoxifen, since the results aren’t reliable and could end up causing more stress than necessary. She recommends waiting 3 months after stopping tamoxifen before undergoing any type of testing.

Many young women will be able to get pregnant naturally after breast cancer treatment. Worried that it might not be working for you? Dr. Kondapalli says for women under 35, you don’t necessarily need to stress about fertility testing until you’ve been at it for a year. For women above 35, you may want to talk to a fertility expert if you’ve been trying for 6 months without a successful pregnancy.

However, waiting a year to get pregnant might not be feasible. For young women who are taking a break from tamoxifen with the caveat that they will start it again asap, trying to get pregnant for a full year might be too long. Some oncologists are eager to get their patients back on tamoxifen as quickly as possible. In these cases, Dr. Kondapalli recommends trying for 6 months, and then seeking out a specialist.

Don’t get pregnant while on Tamoxifen! This is a major no-no, as tamoxifen can harm the fetus. Dr. Kondapalli says to wait 3 months before trying to conceive, after stopping tamoxifen.

There are fertility options for women after breast cancer. If you weren’t able to do fertility preservation prior to cancer treatment and are now having difficulties getting pregnant, there are still options available to you such as fertility drugs or IVF. For women who’ve had hormone-sensitive cancer, there are medications you can take while undergoing fertility treatment to minimize the amount of estrogen in your body.

Current data shows fertility treatments are safe for women who have had breast cancer. Disease-free survival has been shown to be equal among pre-menopausal breast cancer survivors who underwent fertility treatments compared to those who did not.

There are many different ways to have a family if it is something you want! If you’re a young woman who’s been diagnosed with breast cancer and you want to start a family (or add to the one you already have), know that you have options. Seek out the advice of a fertility specialist who works with cancer patients and figure out the path that makes the most sense for you.

I found it really helpful to talk with Dr. Kondapalli and I hope her insights can help put other young women’s minds at ease who might having similar concerns. Remember – we’re all in this together.

A big thank-you to Dr. Kondapalli for taking the time to share her knowledge with our audience. Watch my interview with her below for the full conversation.