Within a matter of years, a critical threshold is reached at which the number and the quality of eggs are too low to result in a successful pregnancy. Women generally experience an accelerated decline in fertility at an average age of 37. Throughout a woman’s reproductive years, there is a gradual and natural reduction in the number of eggs and a corresponding decrease in the quality of eggs. Because the duration of treatment is typically 5-10 years, however, many women will experience age-related infertility by the time they complete their tamoxifen. Unlike chemotherapy, hormone therapy is not known to directly damage the ovaries or affect the egg supply. If the remaining pool of eggs is already below a critical threshold immediately following cancer therapy, pregnancy using one’s own eggs may no longer be possible regardless of whether menstrual cycles are occurring. Even in women who resume regular menstrual periods after treatment, there may be a shortened window of time to achieve pregnancy. Premature menopause can happen right away or may come a few years after a woman finishes treatment. Because all women are born with a limited quantity of eggs, which naturally declines over the years until menopause (when the egg supply is essentially depleted), a reduction due to chemotherapy can result in premature menopause in 15 to 89 percent of patients. It is known that chemotherapy, especially medications called alkylating agents (such as Cytoxan® ), can immediately and dramatically reduce a woman’s supply of eggs. Two common components of breast cancer treatment-chemotherapy and hormone therapy-are very effective in decreasing recurrences and improving survival, but these treatments may also negatively affect a woman’s future ability to conceive. Though the diagnosis of cancer itself is not believed to have an impact on a woman’s fertility, certain treatments for cancer do. Q: How does cancer therapy affect fertility?
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