For some people, having a child is non-negotiable, and that can be true even when serious health obstacles get in the way. Comedian Tig Notaro, who underwent treatment for breast cancer a few years ago, revealed in a recent podcast that she was one of those people.
Notaro said on WYNC Studios’ Death, Sex & Money podcast that she had planned to have a child before her life “fell apart” in 2012. Within six months, she contracted a life-threatening infection, her mother died in an accident, and Notaro was diagnosed with stage two bilateral breast cancer. Notaro underwent a double mastectomy, and said her cancer diagnosis and treatment complicated her plans to have in vitro fertilization.
Notaro said her doctor advised against doing IVF and warned that there were potentially deadly risks to her health. But she did it anyway. “I had been so on the track of ‘I’m gonna have a child’ before I was sick, I couldn’t take my eyes off it,” she said.
“I definitely put myself at risk by doing IVF because the kind of cancer that I had is fueled by hormones and IVF just injects you with hormones,” she said. Notaro may be referring to a form of hormone receptor-positive breast cancer, in which cancer cells may receive signals from the hormones estrogen or progesterone that could promote their growth, per the American Cancer Society (ACS).
Notaro’s IVF wasn’t successful, but she said she worries that the risks caused by the hormone injections are still there. “It’s something where if I spend too much time thinking about it, it will bring me great levels of stress and anxiety, but I try to just accept the decision I made,” she said. “Hopefully I’m OK and I will be OK because I am in remission now, but hopefully doing IVF, that won’t rear its head and cancer won’t return.”
She did eventually end up becoming a mom to twin boys, who were conceived with Notaro’s partner’s eggs and carried via surrogate.
There are several steps to IVF and there are often multiple hormonal medications involved.
If you plan to use your own eggs for IVF, your doctor will want to treat you with synthetic hormones to stimulate your ovaries to produce multiple eggs, the Mayo Clinic explains.
That often includes injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH), or a combination of both to stimulate more than one egg to develop at a time, the organization says. When the follicles are ready for retrieval, you’ll usually take human chorionic gonadotropin (HCG) or other medications to help the eggs mature. (Estrogen levels in your body usually increase as follicles develop, the Mayo Clinic points out.) And, on the day of your egg retrieval or at the time of an embryo transfer, your doctor may recommend that you take progesterone supplements to make the lining of your uterus more receptive to implantation, the Mayo Clinic says.
Many breast cancers are sensitive to estrogen, the ACS says, and there has been concern that the high hormone levels during pregnancy might increase the odds that the cancer will come back. However, the ACS says that research has shown that pregnancy does not increase the risk of cancer coming back after a person has been successfully treated for their cancer.
Doctors generally recommend that breast cancer survivors wait at least two years after all of their cancer treatments have finished before they try to get pregnant, per the ACS. It’s not entirely clear whether this is the best amount of time to wait and there have been no data from clinical trials that establishes this, but two years is thought to be enough time to find any early return of cancer, the organization says.
Without knowing the specifics of Notaro’s situation, experts say that IVF is not known to increase the risk of breast cancer recurrence.
Because some types of breast cancer are sensitive to hormonal changes, it's understandable that you might be worried about having extra estrogen and progesterone circulating in your body. But research suggests this doesn't actually increase the risk of recurrence, even if you had hormone receptor-positive breast cancer, Terri Woodward, M.D., an assistant professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, tells SELF.
One retrospective study published in the European Journal of Cancer analyzed data from 198 patients who had a pregnancy after a breast cancer diagnosis. The women were grouped into those who used assisted reproductive technology like IVF and those who didn't. Researchers found that there was no greater risk of cancer recurrence in women who used assisted reproductive technology than those who didn't. However, it's worth noting that this was a small study with only 36 pregnancies from assisted reproductive technology, and not all of those were done with IVF.
“In most cases, we don’t feel that we’re increasing risk any further by allowing a woman who is in remission to undergo IVF after a breast cancer diagnosis,” Dr. Woodward says. However, she adds, she’s “very careful” when she talks to patients to never say that this doesn’t mean their cancer can’t return. “We just don’t believe that we’re increasing the chance of it coming back even more by doing IVF,” she says.
This is largely due to the fact that IVF just involves two weeks of medicine, Dr. Woodward says. “It’s unlikely that two weeks is going to make or break you in terms of cancer prognosis or recurrence,” she says, pointing out that some women even undergo IVF before they’re treated for cancer in order to try to preserve their fertility.
When women want to undergo IVF after having hormone receptor-positive breast cancer, doctors usually tweak the regimen a little by adding an aromatase inhibitor like letrozole, which shuts off the enzyme that converts androgens to estrogen, to decrease the patient’s exposure to estrogen, Leslie Appiah, M.D., an ob/gyn at The Ohio State University who specializes in treating patients who have gone through cancer treatments or currently have cancer, tells SELF. Otherwise, it’s business as usual, she says.
If you want to have IVF after your breast cancer is in remission, talk to your doctor.
Every cancer case is different, and your doctor may have some concerns about your particular case, treatment, or chance of recurrence—that's likely what happened in Notaro's case. If you get the go-ahead, it’s still important to let your reproductive endocrinologist know about your past history of cancer as well so they can tweak your IVF regimen, Dr. Woodward says.
Your doctor will also likely want to have a conversation with your oncologist to go over details of your case, David Diaz, M.D., a reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. Technically, it takes five years for someone to be considered cured from cancer, per the National Cancer Institute, but few women wait that long after breast cancer treatment to undergo IVF if they need it, Dr. Diaz says. That's why it's important for your fertility doctor to have a "frank and open discussion" about your health before you move forward with IVF, Dr. Diaz says.
Also, keep this in mind: Just because you went through breast cancer doesn’t mean you won’t be able to conceive on your own—many people are able to conceive afterward, the ACS says. Still, some treatments can make it harder to get pregnant than others, so it’s important to talk to your doctor about your fertility options before you even undergo treatment.
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