ESR1 and Infertility: Besides for leading to a significantly lower survival in ERα negative tumors as compared to ERα expressing tumors, this treatment option burdens patients with the adverse effects of chemo-toxicity such as alopecia, myelosuppression, gastrointestinal disturbances, nephrotoxicity, neurotoxicity, cardiotoxicity, and infertility, calling into question any benefit from chemotherapy at the cost of a reduced quality of life [23].