A breast cancer diagnosis can shake a young woman’s world. Suddenly there’s an overwhelming flood of information to process, decisions to make, and treatments to face. For younger women with breast cancer, fertility is often a major concern [1]. Some may worry about how their concerns could upset their partner, while others fear being rejected when forming new relationships [2]. In contrast, older breast cancer patients may be less concerned about fertility if they’ve already had children or decided not to have any before their diagnosis [3]. Emotional Support Makes All the DifferenceWatching someone you love go through a cancer diagnosis is tough, and it’s normal to feel uncertain about how to be there for them.An important way to support them is to be present, listen without judgement, and create a safe space where they can freely express emotions and voice out concerns [4]. Support from loved ones and health providers can help reduce the stress of a cancer diagnosis [5]. Your loved one might feel frustration or anger at their diagnosis, and may sometimes direct these feelings at you. This can hurt, but it’s important to remember that your partner is upset at their condition, not with you [4]. Your presence and patience matter, even when you feel lost. Navigating Fertility Concerns TogetherIn addition to emotional support, addressing practical concerns about fertility can help your partner feel supported. If having children is important to both you and your partner, it’s crucial to speak to the doctor before starting treatment.Here are some common questions you might have as a partner:Will breast cancer treatment affect my partner’s ability to become pregnant in the future?Every patient’s cancer is different, so treatment plans are personalised based on individual needs and preferences. While procedures like surgery may not affect fertility, treatments like chemotherapy may affect ovarian function and hence fertility [6].Can fertility be preserved during treatment?Fertility preservation may be possible. This process saves or protects your loved one’s embryos, eggs or ovarian tissue so they can be used to have children in the future [7]. Options may include [8]:Embryo freezing and In vitro fertilisation: Eggs are removed and fertilised with sperm in a lab, creating an embryo that is frozen and stored for later use.Egg freezing: Eggs are collected and frozen. This method may be used if a woman does not have a male partner and is not keen on using donor sperm. Ovarian tissue freezing: Ovarian tissue is surgically removed and frozen in a process called cryopreservation. The tissue is reimplanted after treatment. If the tissue begins working normally again, the ovaries may produce eggs, allowing you and your partner to naturally try for a baby. As a couple, it’s important to remember that while these options offer opportunities to try for children post-treatment, they may not always result in pregnancy.Should we be on birth control during her treatment?Women are advised to avoid getting pregnant during breast cancer treatment, as it can complicate treatment and risks abnormalities to the unborn baby. Discuss with your loved one’s doctor about suitable birth control options and explore what’s best for your situation. In principle, since breast cancer is often related to hormonal activity in the body, hormone-based contraception such as birth control pills will not be advisable. Instead, barrier contraception such as a condom or cap is preferred. [9] [10].After her treatment, how soon can we try for pregnancy?In general, doctors may advise waiting at least two years after completing treatment to get pregnant, due to worries about cancer recurrence [11] [12]. The wait time can vary depending on the type of cancer and stage, the treatment received and age [13].Some hormones that increase during pregnancy can potentially cause breast cancer cells to grow, and undergoing cancer treatment during pregnancy can be complex [13]. Are there risks to the baby if my partner becomes pregnant post-treatment?A history of breast cancer has been linked to complications such as low birth-weight, early birth and the need for a caesarean section. However, research has not found that a woman’s past breast cancer has direct effects on the baby, such as birth defects or long-term health concerns [14] [15]. However, medications such as Tamoxifen (which has to be taken for several years), can cause harm to the developing foetus. Hence, precautions to avoid pregnancy should be taken when receiving Tamoxifen treatment. Will a future pregnancy put my partner at risk of breast cancer recurrence?Since breast cancer is a hormone-driven disease, and pregnancy increases hormone levels, it’s understandable to worry about cancer coming back, particularly those with hormone-positive breast cancer [16].However, studies have not shown that pregnancy increases the risk of cancer returning. In most cases, pregnancies are generally considered safe for the mother [15] [16].  A recent large study suggested interrupting hormone therapy for pregnancy did not worsen the outcome of breast cancer [17]. However, as individual cancer risk varies, this will have to be discussed with the oncologist.  Open conversations and gathering as much information as possible can offer you and your partner clarity and reassurance. With something as life-altering as breast cancer, making informed decisions will help you move forward together with confidence. Sexual Health and Intimacy: Braving New ChallengesWhile addressing your partner’s fertility concerns is important, it’s also vital to consider the emotional and physical changes that can affect intimacy and sexual well-being. Sexual health concerns are also common and distressing for women after a breast cancer diagnosis [18].Physical changes, particularly after surgeries like a mastectomy, can affect how some women feel about their bodies. Treatments that affect hormone levels like chemotherapy and hormone therapy may impact your partner’s sexual interest [19]. Mental strain and fatigue from treatment can also make intimacy challenging. As their partner, you can help by being sensitive to these changes and communicating openly to avoid misunderstanding. If you’re worried about causing hurt or discomfort, let them know. Ask how your partner feels and respect their boundaries. Intimacy does not always have to be sexual, it can be small gestures like hugging or simply being close to each other [4]. While navigating these changes can be challenging, it can also present new ways to stay connected and grow as a couple. Navigating breast cancer and its impact on fertility and sexual health can be challenging for any couple. It’s normal to feel overwhelmed by the uncertainty, but speaking with health professionals and leaning on loved ones can make the journey less daunting. Remember, you and your partner are not alone, and with patience and understanding, you can both face it and emerge stronger together. Article reviewed by Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery.References[1] Prevalence and impact of fertility concerns in young women with breast cancer. [2] Talking but not always understanding: couple communication about infertility concerns after cancer [3] Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer [4] Breast Cancer Now, My partner has breast cancer [5] Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment [6] National Breast Cancer Foundation Inc., Does Breast Cancer Treatment Affect Fertility? [7] American Cancer Society, Preserving Your Fertility When You Have Cancer (Women) [8] Cancer Research UK, Preserving Fertility and Breast Cancer [9] Cancer Council Australia, Cancer Fertility Preservation [10] NHS, Contraception and pregnancy during cancer treatment: Information for patients [11] Breastcancer.org, Fertility and Pregnancy After Breast Cancer [12] Breast Cancer Now, Planning pregnancy after breast cancer treatment[13] American Cancer Society, Having a Baby After Cancer: Pregnancy [14] American Cancer Society, Pregnancy After Breast Cancer [15] Breastcancer.org, Pregnancy Is Safe After a Breast Cancer Diagnosis, Study Shows[16] Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis [17] Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer [18]  Women's insights on sexual health after breast cancer (WISH-BREAST)[19] American Cancer Society, Body Image and Sexuality After Breast Cancer