title: Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes.
abstract: Breast cancer is the most frequently occurring cancer in women of reproductive age, and systemic treatments may adversely affect childbearing plans. Use of assisted reproductive technologies and therapies for ovarian protection improve fertility prospects. We evaluated whether patients had a documented fertility discussion (FD) with their oncology physician prior to therapy, what options were chosen, and if pregnancy was achieved.
  
  
  
  A retrospective chart review from 2006 to 2014 was performed to evaluate women aged 40 years and younger who were diagnosed with breast cancer and treated with chemotherapy and/or antihormonal therapy. Patient demographics, treatment regimens, presence or absence of FD, in vitro fertilization (IVF) consultation, gonadotropin-releasing hormone (GnRH) agonist use, and subsequent successful pregnancy were analyzed.
  
  
  
  Among 303 patients meeting the inclusion criteria, 80 (26 %) had an FD with their physician documented; 71 of these 80 women (89 %) sought further fertility consultation and options. Sixteen (20 %) women were prescribed a GnRH agonist only for ovarian protection during chemotherapy, 50 (63 %) underwent IVF consultation only, and 5 (6 %) had both a GnRH agonist prescribed and an IVF consultation. The overall pregnancy rate was 7 % at a mean of 3 years post breast cancer treatment. Pregnancy after treatment was more common among those pursuing IVF consultation or prescribed a GnRH agonist.
  
  
  
  In treating young breast cancer patients, it is important to assess fertility desire, discuss treatment risks relating to fertility, and discuss preservation options. Although not every woman in this group desired pregnancy, 71/80 (89 %) women having a documented FD sought further fertility consultation and options.
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA. devinamccray@gmail.com.
authors.forename: Devina K S
authors.initials: DK
authors.lastname: McCray
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Simpson
authors.affiliation: Cleveland Clinic Foundation, Obstetrics/Gynecology and Women's Health Institute, Cleveland, OH, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Flyckt
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA.
authors.forename: Yitian
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Cleveland Clinic Foundation, Quantitative Health Services, Cleveland, OH, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Crowe
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.affiliation: Cleveland Clinic Foundation, Hematology Oncology, Cleveland, OH, USA.
authors.forename: Halle C
authors.initials: HC
authors.lastname: Moore
authors.affiliation: Cleveland Clinic Foundation, Breast Surgical Oncology, Cleveland, OH, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Valente
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy*; D003142:Communication; D005260:Female; D005298:Fertility; D059247:Fertility Preservation; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone