October Is Breast Cancer Awareness Month.  But Let's Center Fertility, too

When you hear "1 in 8 women will face breast cancer," it's easy to think of statistics. But behind every number is a real woman with real dreams—including, for many, the dream of having children.

If you're reading this because you or someone you love just got diagnosed, I want you to know something important: fertility preservation is possible. But here's the hard truth—you need to talk about it now, not later. Not after you've processed the diagnosis. Not after you've told your family.

I know that feels overwhelming when you're still trying to absorb the words "you have cancer." But timing matters more than almost anything else when it comes to protecting your fertility.

Why Treatment Puts Your Fertility at Risk

Let's be honest about what breast cancer treatment does to your body.

Chemotherapy is the biggest threat. Some chemo drugs—especially the ones called alkylating agents, like cyclophosphamide—can damage the eggs in your ovaries. For some women, this leads to early menopause, sometimes even before treatment ends. The specific drugs you'll receive, the doses, and how long you're on them all play a role in how much your fertility is affected.

Hormonal therapies like tamoxifen don't destroy your eggs directly, but here's the catch: you'll likely need to take them for 5 to 10 years. If you're 32 when you're diagnosed, that means waiting until you're 37 or 42 to even try getting pregnant. And as any fertility doctor will tell you, those years matter. A lot.

Radiation aimed at your breast usually won't affect your ovaries, but if radiation hits your pelvis or abdomen for any reason, that's a different story.

Your age when you start treatment also matters enormously. Women in their 20s typically have more eggs in reserve and may bounce back better. By your late 30s and early 40s, you're already facing natural fertility decline and cancer treatment accelerates that timeline dramatically.

Your Fertility Preservation Options (And Why You Need to Decide Fast)

Here's what most women don't realize: nearly all fertility preservation needs to happen before you start cancer treatment. That means you have a very short window, often just 2 to 4 weeks, to make life-changing decisions while you're still reeling from your diagnosis.

It's not fair. But it's reality. So let's talk about your options.

Freezing Your Eggs

This is the most common choice for women who don't have a partner or aren't ready to use donor sperm.

How it works: You'll give yourself hormone injections for about two weeks to stimulate your ovaries. Then, in a quick outpatient procedure, doctors retrieve your eggs and freeze them using a technique called vitrification. Later—maybe years later—those eggs can be thawed, fertilized, and transferred to your uterus.

The timeline: Plan on 2 to 6 weeks from start to finish, depending on where you are in your cycle when you begin.

Success rates: Modern egg freezing is really good. Your chances of eventually having a baby from frozen eggs are roughly 30-60% per retrieval cycle, heavily dependent on your age when you freeze them.

The financial reality: In the US, UK, and Canada, you're looking at $10,000-$15,000 per cycle (not including medications), plus $500-$1,000 annually for storage. Yes, it's expensive, and that's exactly why more women are looking at alternatives.

Medical tourism for fertility preservation: Albania has emerged as a compelling option, with egg freezing costs around €2,500- €3,000 (without medications) and storage fees of €500 per year. The clinics meet European standards, and the savings can be substantial,potentially freeing up funds for other aspects of your cancer care.

Here's what makes this flexible: you can store your eggs in Albania and later ship them to your home country through licensed international shipping companies that specialize in genetic material transport, or you can choose to continue your fertility treatment at the same Albanian center when you're ready.

If you're considering this route, look for clinics with international accreditation and ask your oncologist about coordinating care across borders. We'll talk more about financial help in a minute.

Freezing Embryos

This is similar to egg freezing, but your retrieved eggs are fertilized with sperm (from a partner or a donor) before freezing.

Why some women choose this: Embryos have historically had slightly higher success rates than frozen eggs, though that gap is shrinking as egg freezing technology improves.

The complication: You need sperm, which means either you have a partner ready to take this step, or you're comfortable choosing a sperm donor right now. For some women facing cancer, making that decision on top of everything else feels like too much.

Freezing Ovarian Tissue

This is newer and still considered experimental in many places, but it's becoming more established.

How it works: Surgeons remove a piece of your ovary, freeze it, and then can transplant it back into your body years later. The tissue can potentially restore both your fertility and your hormone production.

Who it's for: Women who absolutely cannot delay treatment even two weeks, or very young girls going through cancer treatment who can't do egg freezing yet.

The track record: Hundreds of babies have been born worldwide from this method, but it's not available everywhere, and insurance coverage is spotty.

Ovarian Suppression During Chemo

Some doctors recommend monthly shots of medications (GnRH agonists like Lupron) that temporarily shut down your ovaries during chemotherapy, theoretically protecting them from damage.

The truth about this option: The research is mixed. Some studies show it might help preserve ovarian function; others show minimal benefit. The medical consensus right now is that you shouldn't rely on this alone, think of it as a possible add-on to egg or embryo freezing, not a replacement.

The Conversation You Need to Have With Your Doctor Right Now

I wish every oncologist automatically brought up fertility at the first appointment. Some do. Many don't, not because they don't care, but because they're focused on saving your life, which is obviously priority one.

But you have to advocate for yourself here. Ask these questions at your very next appointment:

"How will my specific treatment plan affect my fertility?" Not general statistics, your specific protocol, your specific situation.

"Realistically, how much time do I have before we absolutely must start treatment?" Is it one week? Three weeks? Six? You need an honest answer.

"Can you refer me to a fertility specialist who works with cancer patients today?" Not eventually. Today.

"Are there equally effective treatment options that would be less damaging to my fertility?" Sometimes there are alternatives. Sometimes there aren't. But you deserve to know.

"What are the actual medical risks of delaying treatment by 2-4 weeks to freeze eggs?" For many breast cancer cases, a short delay doesn't significantly impact outcomes, but you need your doctor to confirm this for your specific cancer.

"Does my insurance cover fertility preservation because this is medically necessary?" Many states now require this coverage. Your doctor's office can help you figure this out.

"But Is Pregnancy After Cancer Even Safe?"

This is the fear that keeps women up at night. You go through all this to preserve your fertility, but what if getting pregnant later makes your cancer come back?

Here's what the research actually shows: Pregnancy after breast cancer does not increase your risk of recurrence. Multiple large studies have confirmed this. In fact, some research even suggests pregnancy after breast cancer might be associated with better survival rates, though this could be because healthier women are more likely to get pregnant.

But timing matters. Most oncologists recommend waiting at least 2 years after finishing treatment before trying to conceive. This gives your body time to recover and lets any early recurrences reveal themselves when they're most treatable.

If you're on tamoxifen, you'll need to discuss taking a break from it to get pregnant, since it can cause birth defects. Recent research on "tamoxifen breaks" shows this can be done safely, you can pause treatment, get pregnant, have your baby, and then resume tamoxifen.

What Your Age Means for Your Choices

If You're in Your 20s

You probably have excellent ovarian reserve, which means egg freezing has the best chance of success. But don't let youth make you complacent—cancer treatment can still damage your fertility significantly. Take this seriously.

If You're in Your 30s

You're in the decade where every year counts. Natural fertility starts declining, and cancer treatment will accelerate that decline. This is not a time to wait and see, act immediately.

If You're in Your Early 40s

I'm going to be straight with you: your ovarian reserve is likely already declining naturally, and treatment will probably push you into early menopause. Egg freezing might still be worth trying, but you need to have an honest conversation with a fertility specialist about realistic expectations. Donor eggs might be part of your path to motherhood, and that's okay.

The Emotional Weight of All This

Can we acknowledge how impossibly hard this is? You just found out you have cancer, a disease that could destroy you, and now you're supposed to make major life decisions about hypothetical future children while you're still in shock.

You might feel:

Guilty for "delaying" treatment when every fiber of your being says you should start killing cancer cells right now.

Angry that you have to choose between treating your cancer and preserving your fertility, why can't both just happen?

Isolated because friends who haven't been through this can't really understand the specific grief of potentially losing your fertility before you even had a chance to use it.

Rushed to make decisions about sperm donors or partners when you're not emotionally ready.

All of these feelings are valid. Every single one.

But please hear this: Taking 2-4 weeks to preserve your fertility is not selfish. It's self-care. It's not choosing between your life and your future family, it's choosing both. Research shows that when women preserve their fertility, their psychological outcomes are better, their distress is lower, and their quality of life improves, even if they never end up using those frozen eggs.

Sometimes just knowing you have options is healing in itself.

Your Action Plan for This Week

I know you're overwhelmed. Let me make this as simple as possible.

In the next 48 hours:

• Tell your oncologist: "I want to discuss fertility preservation. I need a referral to a reproductive endocrinologist who works with cancer patients."
• Call that fertility clinic and say it's urgent, you're a cancer patient with a limited timeline.
• Start documenting your insurance coverage for fertility preservation.

Within week one:

• Meet with the fertility specialist (most will see you within days for cancer cases).
• Get your fertility testing: blood work to check hormone levels and an ultrasound to count your remaining eggs.
• Decide which preservation method makes sense for your situation.
• Start the insurance authorization process or figure out payment plans.

Weeks 2-4:

• If you're doing egg or embryo freezing, you'll do your stimulation cycle and retrieval.
• Finalize your storage arrangements with the fertility clinic.
• Coordinate with your oncologist on when you'll start cancer treatment.

Moving forward:

• Keep all your fertility records organized in one place.
• During and after treatment, monitor your ovarian function with your doctors.
• Stay in touch with your fertility clinic, they're part of your care team now.

The Bottom Line: Your Future Self Will Thank You

Here's what I want you to remember when you're lying awake at 3 AM, terrified and overwhelmed:

You are not choosing between surviving cancer and having children. You're fighting for both.

You are not being dramatic for caring about your fertility when you have cancer. Your future matters. Your dreams matter.

You are not alone. Thousands of women have walked this path before you, and thousands more will walk it after you. There are support groups, counselors, and online communities full of women who get it.

The single most important thing you can do is act fast. Don't wait for your doctor to bring it up. Don't wait until you've "processed" your diagnosis. Don't wait until you've finished researching every option. Start the conversation today.

Because the truth is, breast cancer may be trying to steal your future, but you don't have to let it.

 

Important Note: This article provides general information about breast cancer and fertility preservation. Every woman's situation is unique, and this is not a substitute for personalized medical advice. Always consult with your oncologist and a fertility specialist about your specific circumstances before making any decisions.

If You Need Help Now:

• Livestrong Fertility: Financial assistance and medication discounts — livestrong.org/we-can-help/fertility
• Alliance for Fertility Preservation: Resources and support — allianceforfertilitypreservation.org
• ASCO Guidelines: Evidence-based fertility preservation recommendations — asco.org
• Net: Information on fertility concerns for cancer patients — cancer.net

 

Your voice matters: If you've been through this—whether you preserved your fertility, decided not to, or had your options taken away, your story could help another woman who's facing this decision right now. Share your experience in the comments if you feel comfortable. We're all in this together.

Selected References (for your further reading):

• ASCO Guideline Update: Fertility Preservation in People With Cancer (ASCO Publications)
• Safety of Pregnancy After Breast Cancer: Systematic Reviews & Meta-analyses (ASCO Publications)
• Fertility Preservation Programmatic Recommendations (ASRM / Oncofertility) (ASRM)
• Reproductive Outcomes After Breast Cancer Survivorship (JAMA Network)

Psychological Impact of Fertility Counseling in Young Patients (PMC)