The effect chemotherapy has on fertility, and whether it is temporary or permanent, depends on a number of factors. These include:
- the chemotherapy drugs used
- the dose of the drug
- whether it is given in combination with other chemotherapy drugs
- your age
Age is very important. The closer you are to the menopause the greater the risk your fertility will be affected. Women over 40 will be much more at risk than those in their 20s or 30s.
Chemotherapy can be used for early breast cancer to reduce the risk of breast cancer returning. This is called adjuvant therapy. There are a number of different types of chemotherapy (regimens). The choice of regimen depends on several factors including a woman's risk of recurrence and general health.
Four of the most widely used treatments are CMF, Epi-CMF, FEC and AC. Cyclophosphamide is part of all of these treatments. It is the drug most likely to reduce fertility.
Usually six courses of chemotherapy are given as adjuvant treatment for breast cancer. But, for some women, who have a relatively low risk of recurrence, four courses of AC chemotherapy may be sufficient. This means they receive a lower total dose of cyclophosphamide.
For the CMF and FEC treatments the risk of an early menopause, and infertility, clearly relates to age. Only 1 in 10 to 1 in 20 women of 30 years of age are likely to have their periods stop. By the age of 35 the figure rises to about 1 in 6 to 7. By the age of 40, 2 out of 5 women are likely to be affected. By the age of 45 almost three quarters of women having CMF or FEC will enter the menopause.
For women who have six courses of AC chemotherapy the chances of infertility are probably much the same as with CMF or FEC. But with four courses of AC the risk of bringing on the menopause is significantly reduced.
If fertility is an important issue for you discuss this with your specialist. So that, if there is a choice of chemotherapy treatments suitable for your circumstances, you can opt for the one which carries the smallest risk of becoming infertile.