Breast cancer Treatment and Fertility Preservation: A Narrative Review of Impacts, Strategies and Ethical Considerations

Purpose of review: At present, breast cancer represents the most common malignancy diagnosed in women worldwide. Due to the trend toward delayed childbearing, many women of reproductive age are being diagnosed with breast cancer and treated with chemotherapy or hormone therapy which can adversely affect their fertility. This literature review discusses the effects of breast cancer treatment on fertility and options for fertility preservation.

Recent findings: Treatments used in the management of breast cancer often result in a diminished ovarian reserve, premature ovarian insufficiency, and treatment-related amenorrhea. Chemotherapy may cause direct damage to oocytes and deplete ovarian reserve, while hormone therapies such as tamoxifen can cause amenorrhea and delay childbearing. Targeted therapies and radiotherapy may also pose risks to reproductive health. Fertility preservation is a concern for patients, and many of them may refuse or prematurely discontinue treatment to preserve their fertility. It is relevant to incorporate considerations of fertility at the time of treatment planning for breast cancers and to provide information to appropriate patients regarding their options. Current techniques available for fertility preservation include ovarian suppression, oocyte and embryo cryopreservation, and ovarian tissue cryopreservation. In spite of these techniques being in existence, there are plenty of barriers that deter the patients from availing them, including lack of awareness, financial constraints, and the need for timely treatment. This review implicates that these challenges require multidisciplinary approaches and a patient-centered approach. Further research is warranted toward the improvement of fertility preservation techniques, individual variability in protocols, and newer advances in reproductive medicine to further optimize quality of life in survivors of breast cancer.