Fertility Counseling and Preservation in Breast Cancer

Abstract

Young women represent a minority of breast cancer patients for which fertility, family planning, and pregnancy represent unique vulnerabilities. This review intends to discuss recent published evidence regarding treatment-related infertility, fertility counseling, and preservation. Fertility concerns are common among young women with breast cancer and may negatively affect treatment decisions. Data is available to aid providers in approximating odds of post-treatment amenorrhea and infertility. Multiple fertility preservation techniques are available. While embryo preservation is most commonly used, recent guidelines endorse oocyte preservation and support for ovarian tissue cryopreservation is increasing. Most recently, the contribution of ovarian suppression during chemotherapy to ovarian function preservation has been established. Germline BRCA mutations may impact fertility potential and challenge fertility preservation and preimplantation genetic testing should be discussed with this subset. Fertility counseling and preservation have become an integral part of the multidisciplinary care for breast cancer at diagnosis and throughout survivorship. Efforts to further individualize recommendations are necessary.