What is your approach to timing fertility preservation consultations in newly diagnosed breast cancer patients?

Highlights

• Fertility preservation consultations for newly diagnosed breast cancer patients should be initiated immediately, ideally before any treatment begins.
• The start of chemotherapy is the critical deadline, as egg or embryo freezing is not possible once it has commenced.
• Egg or embryo freezing typically requires a two-to-three-week timeline, making an early referral essential for treatment planning.
• A patient's treatment sequence is a key factor, as having surgery before chemotherapy can create a larger preservation window.
• Fertility specialists can collaborate with the entire oncology team to integrate a preservation protocol into the patient's treatment timeline.

Article

The Imperative for Immediate Referral

For newly diagnosed breast cancer patients, the timing of a fertility preservation consultation is critical and brooks no delay. A consensus among experts in reproductive endocrinology and oncology underscores that this referral should occur immediately upon diagnosis. Dr. Anate Brauer, a reproductive endocrinologist, states this should be "one of the first conversations" a patient has, advising that a referral be made "as soon as you possibly can." This sentiment is echoed by Dr. Anastasia Martynova, a medical oncologist, who urges a consultation "as soon as possible after breast cancer diagnosis," and by reproductive endocrinologist Dr. Joseph Letourneau, who advises patients to raise fertility concerns with "the first doctor that you encounter." The experts acknowledge the patient's experience can be overwhelming, with numerous appointments and high anxiety, making it incumbent upon the diagnosing or treating physician to initiate this vital conversation proactively.

"This should be one of the first conversations you have." Dr. Anate Brauer

The Non-Negotiable Window Before Chemotherapy

The primary driver for this urgency is the impending start of chemotherapy, which represents a point of no return for oocyte or embryo cryopreservation. Dr. Letourneau clearly states, "Once chemotherapy has commenced or started, we can generally no longer do egg or embryo freezing." He further clarifies the procedural timeline, noting that the stimulation and retrieval process "often takes at least two to three weeks." Therefore, any delay in referral directly jeopardizes the patient's ability to undergo preservation.

Dr. Martynova reinforces this from the oncology perspective, highlighting that the discussion is especially critical "if the cancer treatment includes chemotherapy." The window for intervention is finite and defined by the planned start date for systemic therapy.

"Once chemotherapy has commenced or started, we can generally no longer do egg or embryo freezing." Dr. Joseph Letourneau

The Impact of Treatment Sequencing on Fertility Timelines

Dr. Joseph Letourneau provides a nuanced perspective on how the sequence of breast cancer treatment modalities affects the timeline for fertility preservation. He observes that when a patient undergoes surgery first, followed by adjuvant chemotherapy, it "creates a bigger window in which to freeze eggs or embryos." However, even in this scenario, care must be coordinated to account for the patient's recovery from surgery.

Conversely, the "increasing utilization of chemotherapy first" in a neoadjuvant setting significantly compresses the available timeframe. This modern treatment approach, Dr. Letourneau notes, "does make that importance of coming to see fertility doctors as soon as possible even more important." For oncologists and surgeons, understanding this distinction is crucial for facilitating timely referrals, as the window for intervention in neoadjuvant cases is exceptionally narrow.

A Collaborative and Integrated Approach

Successfully navigating fertility preservation requires seamless collaboration between the patient's entire cancer care team and the reproductive specialist. Dr. Anate Brauer emphasizes that a "fertility doctor can work with the entire care team to develop a protocol and the timeline that's appropriate for their treatment." This integrated approach ensures that the fertility preservation cycle is carefully coordinated with imaging, biopsies, and the initiation of oncologic therapy. By engaging a reproductive endocrinologist early, the oncology team gains a partner who can manage the complex logistics and hormonal protocols required, ensuring the patient’s fertility options are preserved without compromising the timeliness or efficacy of their cancer treatment.

"A fertility doctor can work with the entire care team to develop a protocol and the timeline that's appropriate for their treatment." Dr. Anate Brauer