Fertility Preservation and Pregnancy After Breast Cancer: When and How?

Around 6 % of breast cancer cases occur in women younger than 40 years; these patients show specific issues compared to older women. The effects of local and systemic treatments such as the distortion of body image, sexuality complaints, and fertility reduction have a higher impact in this population of young women. Fertility issues should be discussed before starting any type of anticancer treatment. The optimal type of fertility preservation, the endocrine treatment duration, and the effect of subsequent pregnancies on breast cancer prognosis remain research priorities. Currently, fertility preservation techniques rely on cryopreservation of embryos, cryopreservation of mature oocytes, cryopreservation of ovarian tissue and on the administration of GnRHa concomitant to chemotherapy. Advantages and disadvantages of each technique must be evaluated in each single patient. Many studies have shown that pregnancy after breast cancer does not impair the prognosis, both in ER+ and ER− patients; a protective effect of pregnancy has even been suggested. Young patients should not be undertreated to satisfy their eagerness for pregnancy; physicians should share with them all the available options for fertility preservation and the evidence about safety of pregnancy after cancer, to make a customized and informed decision.