Egg and Embryo Freezing Give Women With Breast Cancer More Options Than Ever

A breast cancer diagnosis can turn life upside down, and starting treatment quickly often takes priority over everything else. For women who hope to have children someday, though, one conversation before treatment can make a lasting difference.

“I know that for that woman in that immediate moment, that’s all she’s thinking about is I just want to live,” said Sheeva Talebian, M.D., a reproductive endocrinologist and director of third-party reproduction at CCRM Fertility of New York.

For Breast Cancer Awareness Month, Talebian explained why fertility belongs in the conversation from the start.

Chemotherapy can affect the ovaries

Breast cancer is highly treatable today, and Talebian noted that women of reproductive age who are diagnosed often “do very well and can go on and have families after their treatment.”

However, many chemotherapy drugs can harm the ovaries. Talebian explained that these treatments “do travel to the ovaries and can negatively affect the quality and the quantity of eggs.”

Age matters as well. Women are born with all the eggs they will ever have, and the number drops faster starting around age 38. For women diagnosed around then, “the chemo on top of natural age-related egg loss is compounded, and many of those women may be in a full menopause after their chemo,” she said. Younger women with more eggs often keep their ovarian function after treatment.

Freezing technology has changed what’s possible

Twenty years ago, this conversation rarely happened.

“Egg freezing was experimental until 2012,” Talebian said. Embryo freezing has also become much more reliable over the past decade.

“Now we have excellent technology to freeze eggs alone, unfertilized, which we didn’t have 20 years ago, as well as embryos,” she said.

Choosing between eggs and embryos

For the patient, the process is the same either way: about two weeks of hormone injections followed by egg retrieval. The difference is what happens next.

Eggs can be frozen on their own, or fertilized with sperm and frozen as embryos. Embryos can be tested for chromosomal problems before freezing, which Talebian said is important because “the No. 1 ingredient to a healthy pregnancy is that embryo is chromosomally intact.” Embryos also survive thawing well. “Embryo survival rates are 99%,” she said.

Frozen eggs can’t be tested in the same way, and “when we go to thaw eggs, we will lose 10% of the eggs in the freeze-thaw process,” Talebian said. Even so, “egg freezing, freezing the egg by itself, and not making embryos is still an excellent technology.”

The right choice depends on the patient’s age, whether she has a committed partner and her personal values. Some women with a partner still choose to freeze only eggs, because with a new cancer diagnosis, making embryos “might just be too much to think about at once,” she said.

Fertility preservation usually fits before treatment

Many patients worry that fertility preservation will delay cancer care. Talebian said the process typically takes no more than two weeks, and that from her understanding of oncologists’ guidance, “a two-week delay doesn’t necessarily change their overall cancer prognosis.”

The process can also start quickly. “A lot of times, they could see us even the day of or the day after their cancer diagnosis, and they can start the injections right away,” she said. Stimulation usually begins with a woman’s period, but specialists now have ways to start at other points in the cycle.

Pregnancy after breast cancer is now a personal decision

Most breast cancers are estrogen or progesterone receptor positive, meaning hormones can fuel their growth.

“Ten years ago, many of these women [who] have estrogen receptor-positive and progesterone receptor-positive breast cancers were told they really should not ever consider being pregnant,” Talebian said. Many turned to surrogacy, which is still recommended for some women.

Newer research suggests that some women with early-stage, hormone receptor-positive breast cancer may be able to carry a pregnancy themselves after treatment. Talebian has treated women who were cleared by their oncologists to do so. However, she stressed that the decision depends on the individual.

“There’s no general statement on this. There’s no general recommendation or rule. It’s very patient-specific,” she said. That decision is made by the patient, her fertility specialist and her oncology team together.

For women who need a surrogate, laws vary by state. In New York, “surrogacy is now legal,” Talebian said. Commercial surrogacy became legal there in 2021, so patients no longer need to move their embryos out of state.

Starting the conversation

Many breast cancer centers now include a fertility coordinator on the care team. Talebian encourages newly diagnosed women to ask their oncology team directly: “Do you have any fertility referrals? This is really important to me.”

During Breast Cancer Awareness Month, that one question can help protect a woman’s future options while she focuses on getting well.