Dr Graff on Fertility Preservation Strategies in Breast Cancer

“The current standard for fertility preservation in breast cancer is a multi-pronged approach. The standard best practice would be embryo preservation, and if not embryo preservation, egg preservation prior to chemotherapy. That means we all have to be thinking early in the diagnosis that a patient needs to be referred to a fertility expertise reproductive endocrinologist to consider their options.”

Stephanie L. Graff, MD, FACP, FASCO, director, breast oncology, Lifespan Cancer Institute; associate professor, medicine, Warren Alpert Medical School; co-leader, Breast Cancer Translational Research Disease Group, Brown University’s Legorreta Cancer Center, discusses current strategies for fertility preservation in patients with breast cancer, including ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists, embryo-oocyte cryopreservation, and combinatorial approaches.

The current standard for fertility preservation in female patients with breast cancer involves a multi-pronged approach that prioritizes early referral to a fertility specialist, Graff begins. Embryo preservation remains the gold standard, followed by egg preservation, both of which are typically pursued before initiating chemotherapy, she states. This highlights the importance of incorporating fertility discussions into the early stages of diagnosis and ensuring timely referral to a reproductive endocrinologist with fertility expertise to explore preservation options, Graff emphasizes.

For patients who decline or are unable to pursue traditional fertility preservation due to personal preferences or barriers, ovarian preservation using GnRH agonists during chemotherapy is still recommended, Graff continues. GnRH agonists can help protect ovarian function during treatment, increasing the likelihood of future fertility, she explains. Additionally, even for those who successfully undergo embryo or egg preservation, the use of GnRH agonists further enhances the chances of maintaining ovarian function, which is essential if the patient wishes to carry their preserved embryos or eggs in the future, Graff says.

It is crucial to acknowledge that fertility preservation considerations also apply to male patients with breast cancer, although this group is less commonly affected, Graff notes. Younger men diagnosed with breast cancer are at risk of treatment-induced infertility and should be referred for sperm banking prior to starting chemotherapy, she concludes.