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Pregnancy After Breast Cancer Treatment: Know Your Options

Posted on November 14, 2022
Medically reviewed by
Richard LoCicero, M.D.
Article written by
Amanda Jacot, PharmD

  • Many breast cancer treatments can cause problems with fertility or even lead to permanent infertility.
  • Pregnancy after breast cancer treatment can be safe for both the mother and the baby.
  • If you want to become pregnant in the future, talk with your cancer care team before you start treatment so that you understand all your options.

Some breast cancer treatments can make it harder to become pregnant or even lead to medical menopause (menopause caused by treatment) and permanent infertility. However, you can still have a healthy pregnancy after undergoing treatment for breast cancer.

Although breast cancer is more common in older people, about 9 percent of breast cancers in the United States are diagnosed in women who are younger than 45 years old, according to the Centers for Disease Control and Prevention (CDC).

Whether you’re currently planning to add to your family or unsure what the future will bring, it’s important to talk with your cancer care team before you start treatment. Planning ahead can ensure you have more options open to you should you want to become pregnant after breast cancer treatment.

Assessing Fertility

Fertility refers to the ability to have children. At birth, a person’s ovaries contain a certain number of eggs, and they don’t produce any new eggs during their lifetime. Every month, the ovaries release at least one egg. Pregnancy can occur if the egg is fertilized by sperm and then implants itself into the uterus (womb). If the egg is not fertilized, you will have a menstrual period.

If a person is trying to become pregnant but can’t, this is referred to as infertility.

With age, the amount and quality of the eggs continue to reduce. The transition to menopause generally occurs between ages 45 and 55. A person is considered to have gone through menopause 12 months after their last period.

Fertility Tests

To test fertility, your doctor can check your hormone levels using blood tests and see how many eggs are available for ovulation. Ultrasound and X-ray imaging can be done to look for problems in the uterus and ovaries.

How Can Breast Cancer Treatment Affect Fertility?

The type of breast cancer treatment you receive will depend on the type and stage of your cancer.

Your risk of infertility depends on several factors, including:

  • Your age
  • Your fertility before treatment
  • Type of treatment
  • Dosage of treatment

Some breast cancer treatments can cause menopause to happen sooner and more abruptly than it would naturally. This is called medical menopause.

On MyBCTeam, many members have faced decisions about treatment and how it will affect their fertility. One member shared, “My oncologist is trying to put me into early menopause because I am hormone-positive. My heart aches for women who haven’t had all the children they want yet, and are going through this with the possibility of losing their fertility.”

Chemotherapy

Chemotherapy (chemo) works by killing any cells that divide quickly. Cancer cells usually divide rapidly, so they are good targets for chemotherapy. However, chemo can’t tell the difference between a fast-growing cancer cell and a fast-growing healthy cell, so it can kill healthy cells along with cancer cells.

The cells in the ovaries grow quickly, so they can be affected by chemotherapy. This can cause a decrease in hormones related to fertility, resulting in medical menopause.

The ovaries may recover after chemotherapy in a few months or years, but sometimes the damage can be permanent.

Chemotherapy drugs associated with loss of fertility include:

  • Cyclophosphamide (Cytoxan)
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Paclitaxel (Abraxane)
  • Thiotepa (Thioplex)
  • Vinblastine (Velban)

Chemotherapy drugs with a lower risk of causing infertility include:

  • 5-fluorouracil
  • Epirubicin hydrochloride (Ellence)
  • Gemcitabine (Gemzar)
  • Methotrexate (sold as Rheumatrex and Trexall)

Hormone Therapy

Hormone therapy can be used to prevent breast cancer from returning after surgery. The treatment is usually taken for at least five years after surgery.

According to the American Cancer Society, women who have not gone through menopause usually take tamoxifen for at least five years after surgery. Tamoxifen (sold under brand names including Nolvadex and Soltamox) blocks estrogen from breast cancer cells, which can encourage the cancer to grow.

Tamoxifen can cause side effects that are similar to menopause symptoms, such as hot flashes, vaginal dryness, or changes in your menstrual cycle. However, it’s still possible to become pregnant while taking this drug. Importantly, tamoxifen may harm the baby, so it’s recommended to avoid getting pregnant while using this treatment.

If you wish to have children in less than five years, you can ask your health care provider about taking a break from tamoxifen while you try to become pregnant and during pregnancy. You can start taking tamoxifen again after your baby is born.

Some members of MyBCTeam have discussed these topics with their oncology team. “I’ve been on tamoxifen for two years, and my doctors and I have started the baby chat,” shared one member.

Targeted Therapy and Immunotherapy

Because targeted therapy and immunotherapy are new treatments for breast cancer, many of their long-term effects are unknown. Talk to your doctor about how targeted therapy can affect your fertility.

Surgery

People at very high risk of developing breast cancer may consider preventive surgery called oophorectomy (removal of ovaries) to reduce their risk of developing breast cancer. Removing the ovaries will make pregnancy impossible, because the ovaries contain the eggs necessary for pregnancy.

Fertility Preservation

Talk to your cancer care team about your fertility and family planning before starting treatment. Your doctor may refer you to a fertility specialist.

Natural pregnancy may be possible after cancer treatment, but you should be aware of other options before starting cancer therapy. Keep in mind that these methods of preserving fertility don’t work 100 percent of the time.

Fertility preservation methods include freezing:

  • Eggs
  • Embryos (fertilized eggs)
  • Ovarian tissue

People who are likely to be infertile after breast cancer treatment but want children may choose to use donor eggs or embryos, surrogacy (when a person agrees to carry and give birth to a baby for someone else), or adoption.

Fertility options can bring hope to those who look forward to having or growing a family after breast cancer treatment. One MyBCTeam member shared, “Starting my fertility preservation today! So excited.”

Is Pregnancy Safe After Breast Cancer Treatment?

Yes! For those who remain fertile after breast cancer treatment, studies have shown that pregnancy is safe for both the mother and the baby, according to the American Cancer Society. It’s worth noting, however, that women who have had breast cancer are up to 60 percent less likely to become pregnant compared with the general population, according to a study published in the Journal of Clinical Oncology.

Timing Pregnancy After Breast Cancer Treatment

Your doctor may recommend that you wait at least two years after finishing breast cancer treatment before trying to have a baby. This recommendation isn’t based on any research findings. Rather, research shows that if cancer is going to relapse (come back), it will usually happen within the first two years after therapy.

Pregnancy and Risk of Relapse

Studies have shown that pregnancy doesn’t increase a person’s risk of breast cancer returning, even for people with cancers sensitive to hormones like estrogen. In fact, people who become pregnant after breast cancer treatment may live longer than those who don’t.

Pregnancy Complications

Previous breast cancer is also linked to an increased risk of some complications in pregnancy, such as preterm delivery, low birth weight, and need for a cesarean section. However, researchers have found no increased risk of birth defects or other long-term health conditions in babies born to people with a history of breast cancer.

Breastfeeding

People who have had surgery or radiation on their breasts may have trouble breastfeeding. Additionally, some hormone therapies can be found in breast milk and may affect the baby. Talk with your doctor about whether breastfeeding will be possible after your specific breast cancer treatments.

Preventing Pregnancy During Breast Cancer Treatment

It’s possible to get pregnant while while undergoing chemotherapy or taking hormone therapies, even if you don’t have a period. Hormonal birth control is usually not recommended for people with a history of breast cancer. Most doctors advise using barrier methods such as condoms or a nonhormonal intrauterine device (IUD), such as a copper IUD.

Talk With Your Doctor About Family Planning

The best time to discuss family planning with your doctor is before you start breast cancer therapy. Don’t assume your cancer care team will ask you if you want children in the future.

One MyBCTeam member commented, “Fertility was not discussed other than my oncologist knowing that I have no children yet, but definitely want some when this is all said and done.”

Some questions you may want to ask your doctor include:

  • How will my treatment affect my fertility?
  • How soon after finishing treatment can I try to get pregnant?
  • What are my options for fertility preservation?
  • How much does fertility preservation cost?
  • What are my options for preventing pregnancy during breast cancer treatment?

By getting answers early — before you start breast cancer treatment — you’ll be as prepared as possible for becoming pregnant later, should you want to start or expand your family.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 59,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you struggled with infertility after breast cancer treatment? Have you had children after breast cancer treatment? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Richard LoCicero, M.D. has a private practice specializing in hematology and medical oncology at the Longstreet Clinic Cancer Center, in Gainesville, Georgia. Review provided by VeriMed Healthcare Network. Learn more about him here.
Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

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