Twenty-nine, thirty-two. The age at which people are diagnosed with breast cancer is getting younger. Faced with the word "cancer," you naturally want to start treatment as quickly as possible, but there is something you should pause and check at least once. If there is even a little hope left in you of having a child someday, you need to raise the topic of fertility preservation before starting treatment. The order matters. Once chemotherapy begins, your options shrink sharply.
Why is that? Some of the chemotherapy drugs commonly used for breast cancer affect the ovaries directly. When the ovaries that hold the eggs are exposed to the drugs, their function declines, and for some people menstruation never returns. The younger you are, the higher the chance of recovery tends to be, but it is not something to relax about thinking "I am young, so it will be fine." On top of that, if it is hormone-positive breast cancer, you have to take hormone-suppressing medication for five to ten years even after treatment ends, and during that period you must postpone pregnancy. If you were thirty at diagnosis, by the time you finish the medication you will be close to forty. That is why the idea of freezing eggs or embryos in advance, now, before treatment, comes up.
The methods are better organized than you might think. If you are married or have a partner, you freeze embryos; if you are on your own, you freeze only eggs. Both go through a process of taking ovulation-induction injections for a few days and then retrieving the eggs, which usually finishes within about two weeks. In the past there was great worry that these two weeks would delay treatment and be dangerous, but these days a method that can be started at any time regardless of the menstrual cycle has taken hold, so it often proceeds without much disruption to the treatment schedule. For patients who are uneasy about rising hormone levels, a drug that suppresses those levels may be used alongside. If it is before puberty or the situation truly leaves no time, there is also a method of removing and freezing the ovarian tissue itself.
The practical side cannot be left out either. It costs a fair amount, and while receiving the injections your body and mind get quite worn out. Having to make such a decision within a few days right after diagnosis naturally leaves your head spinning. Still, I want to make one thing clear. Freezing eggs does not guarantee pregnancy later, and not freezing them does not make pregnancy impossible. This is closer to "leaving open one possibility for the future." How precious that possibility is to you is, in the end, yours to decide.
So if you have been diagnosed, ask your doctor first. "I do think about having a child later, so what should I take care of before treatment?" That one sentence is enough. In a busy clinic the doctor may not always bring it up first, so it is better not to hesitate and to speak up. If needed, you can ask to be connected to a fertility specialist. It may feel unfair to be told to handle such things at a time when cancer treatment alone is overwhelming. Even so, so that your future self does not regret "I should have asked back then," I hope you will find the courage just this once.
This article contains general information, and please do not forget that the answer fitting your body and situation must, in the end, be found together with your medical team in the consultation room.