Maryam Mehrabi,1,*
1. Ahvaz Jundishapour University of Medical Sciences
Introduction: Breast cancer is the most common malignancy in women with a significant increasing incidence during the reproductive life. Effect of the treatment leads to a premature depletion of the ovarian follicle reserve occurs in more than one-third of patients resulting in permanent infertility. The aim of this study is reviewing breast cancer treatment and infertility.
Methods: This review has been conducted based on analysis of available literature indexed in PubMed database between 2015 and 2022. Specific keywords including “breast cancer” and “infertility” have been used. Experimental and review articles on the mentioned theme were included.
Results: The chemotherapeutic, total dose given, the patient's age at treatment, the drug combination and finally whether targeted therapy is used or not, have been shown to modify the impacts of treatment on fertility rate of the patients. Alkylating agents are the most toxic ones. In young breast cancer patients, there is a trend to modify regimens to achieve less gonadotoxicity. Evidence regarding tamoxifen, the main used endocrine drug, is scarce and controversial on its direct effect on ovarian reserve. There are not enough studies on the impact of aromatase inhibitors on fertility. Also, HER2-directed agents have not yet demonstrated significant ovarian toxicity and there are scarce data on their effect on fertility.
Conclusion: Fertility impairment induced by adjuvant treatments and potential risk associated with pregnancy are not well studied and no standard strategy to preserve fertility in breast cancer patients is available so far. More studies are required.
Keywords: Breast cancer treatment; Fertility; Infertility