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Breast cancer treatments bring adverse consequences that interfere with everyday functioning. Importantly, some of these treatments are associated with the reproductive health and child bearing potential. Tamoxifen is a selective estrogen receptor modulator and is a common endocrine therapy treatment for breast cancer.

This study aims to find out the impact of tamoxifen on fertility in women who have been treated for breast cancer.

 331 female breast cancer survivors between ages 25 and 48 years, who were diagnosed between ages 20 and 42 and were at least 3 years post treatment ( average time 3 – 10 years post treatment) were interviewed telephonically, in the presence of a chaperone. The data was collected on a pre-selected questionnaire approved by the institutional review board and electronic entries of the interview were made in the patient’s medical record files.

Women who were treated with tamoxifen after their diagnosis of breast cancer were less likely to conceive compared to women who did not receive tamoxifen. Out of the 331 patients, 21 were primarily infertile and another 20 had undergone either ovarian ablation or bilateral oophorectomy and hence, were excluded from the final analysis.

Women who were treated with tamoxifen were substantially less likely to have a child post cancer diagnosis( CI 95%, P value 0.000). Out of the 163 patients on tamoxifen , 9.2 % were able to conceive as compared to 29.1% in the non tamoxifen arm. In order to further elucidate the link between tamoxifen and its late reproductive effects in cancer survivors, the patients were further cohorted based on their chemotherapy regimens , length of chemotherapy and adjuvant radiotherapy.

Our results suggest that breast cancer survivors who took tamoxifen were significantly less likely to have a child post treatment as compared to patients who did not receive tamoxifen. Similarly there was a significant delay in time to child bearing post treatment, in women who were receiving tamoxifen as compared to those who were not on tamoxifen.

One of the most obvious reasons for this could be chalked upto the fact that patients on tamoxifen prophylaxis are advised against child bearing and conception keeping in view the fact that tamoxifen is a known teratogen. However, Many of the patients have reported not taking any extra precautions or contraceptive measures post their treatment. This was either due to societal and social stigmata or due to financial constraints that restrict access to reproductive health services for many women in developing countries. Another possible explanation could be the effects of tamoxifen on endometrium and the lower reproductive tract. Though we used resumption of menstrual cycle as an indirect measure of endometrial health and there was some delay in resumption of menstruation in patients on tamoxifen therapy, this ratio did not reach statistical significance.