Comment on “Fertility Preservation and Fertility Treatment Use in Young Breast Cancer Survivors Reporting a Live Birth”

In women of reproductive age, the most common form of cancer is breast cancer; due to its being the most common, the impact of the malignancy and its treatment on fertility has been well-characterized. Individual risks to fertility are difficult to quantify; however, based on available evidence, clinical recommendations conclude that patients should be referred for fertility preservation if interested. Some studies suggest that the majority of pregnancies that occur after breast cancer treatment are spontaneous, but there is limited evidence surrounding fertility treatment and outcomes in this patient demographic. This study was designed to assess long-term outcomes of fertility preservation and treatment among women who had a live birth after being diagnosed with breast cancer. This was a multicenter prospective cohort study of women who were diagnosed with breast cancer before the age of 40 between the years 2006 and 2016, and was titled the Young Women’s Breast Cancer Study (YWS). Individuals who had been diagnosed with breast cancer in stages 0 to III and reported a subsequent live birth were recruited for a survey concerning the mode of conception and the use of fertility treatment. A total of 115 patients completed the survey, with patients excluded due to incomplete responses (1), diagnosis of breast cancer during pregnancy (18), using a surrogate (2), or adopting (1). Final analysis included 94 patients, and the median time to the survey after the first childbirth after breast cancer diagnosis was 5 years. The majority of patients were diagnosed with stage I or II hormone receptor-positive breast cancer; at the time of diagnosis, 51% of patients were nulligravida, and 15% were BRCA 1 or BRCA 2 carriers. The majority of patients also received chemotherapy and endocrine therapy (67% and 65%, respectively). Median time to first childbirth after cancer diagnosis was 4.9 years. A total of 35% of patients who completed the survey used fertility preservation after diagnosis and before treatment for breast cancer. Of these, 33% used frozen oocytes or embryos to conceive (12% of live births in this cohort). Most patients who conceived using fertility treatment were more than 35 years of age at cancer diagnosis, and 29% of patients who conceived spontaneously underwent fertility preservation as well. The most common reasons for fertility treatment were known infertility before cancer diagnosis, wanting to resume cancer treatment quickly, and infertility after cancer treatment. Of patients who underwent in vitro fertilization, 38% used oocytes or embryos obtained during fertility preservation, 45% used oocytes or embryos obtained after cancer treatment, and 17% used donor oocytes or embryos. A total of 69% of patients who used fertility treatment attempted spontaneous conception, and when compared with those who conceived spontaneously, those who used treatment were more likely to be nulligravida when diagnosed with cancer and less likely to be BRCA carriers ( P < 0.0001 and P = 0.029, respectively). This study was limited by a small sample size and a homogenous patient population, as well as the fact that pregnancy loss was not within the scope of this study. Future research should attempt to address these factors as well as assess other factors affecting the utilization of fertility preservation in patients with breast cancer who are of reproductive age. (Summarized from Sorouri K, Zheng U, Sella T, et al. Fertility preservation and fertility treatment use in young breast cancer survivors reporting a live birth. Fertil Steril. 2026; 125:166-168. doi: 10.1016/j.fertnstert.2025.09.031)