Cancer & Preserving FertilityCancer treatment can impact fertility in men and women. It is important to talk with your doctor and plan around this. This discussion should include fertility preservation, if this is something you want to consider. Fertility preservation is the process of saving or protecting eggs, sperm, or reproductive tissue to that you can use them to have children in the future.
Fertility preservationSometimes drugs can damage eggs; and there are certain cancer surgeries that require the removal of organs needed to become pregnant. The impact of the treatment can be temporary or sometimes be permanent. It is important that you talk with your doctor before treatment or surgery to decide what is best for you. It is also important to consider the financial implications and risks involved; and to know that there is no guarantee that treatments will work, which is why it is so important to have a thorough understanding of the entire process, as well as getting support for the emotions around this process. When you talk with your healthcare team, make sure to ask about: any impacts to fertility due to treatment; what kind of specialists you need; costs, etc.
Pregnancy After CancerEven with chemotherapy, your normal reproductive cycle can re-align after cancer. This does take time, so speak with your doctor to discuss what your path might look like based on your age, stage and treatment plan.
Egg FreezingEgg freezing is often recommended for fertility preservation. According to the American Cancer Society, “the process of collecting eggs for embryo and egg freezing are the same. However, the timing can be different. Collecting eggs for embryo cryopreservation typically takes several days or weeks, depending on where a woman is in her menstrual cycle. Injectable hormone medications are given for females when they are safe to give. For egg cryopreservation, the time of the menstrual cycle is not as important. For both procedures, a catheter is put through the upper part of the vagina and into the ovary to collect the eggs. Costs vary for these procedures, so check with your insurance company about coverage and ask the fertility specialist what costs are involved with the process. Sometimes these costs can be $10,000 or more each time they are done which may or may not include storage fees. Be sure to ask for a list of all fees and charges, since these differ from one center to another. If you have frozen eggs, embryos, or ovarian tissue, it’s important to stay in contact with the cryopreservation facility to be sure that any yearly storage fees are paid and your address is updated.”
Embryo FreezingEmbryo freezing, or embryo cryopreservation, is an effective way to help preserve fertility for females. Mature eggs are removed from the female and put in a sterile lab dish with several thousand sperm. The goal is for one of the sperm to then fertilize the egg. This is called in vitro fertilization (IVF). In vitro intracytoplasmic sperm injection (IVF-ICSI) involves taking a single sperm and injecting it directly into an egg to fertilize it. In both IVF and IVF-ICSI, the lab dish is observed and if the egg is fertilized, the embryo can be frozen. Later, after treatment ends and the woman is ready to try to get pregnant, the embryo is thawed and put back into the female’s uterus to try to achieve a pregnancy. A woman’s age and menopause status plays a large role in the chances of pregnancy, with a younger age at the time of egg retrieval resulting in higher potential for pregnancy. The quality of the embryos also makes a difference. Some may not survive the thawing process. Some may not implant into the uterus correctly. (American Cancer Society)
Egg (oocyte) FreezingEgg freezing (or oocyte cryopreservation) is also an effective way to help preserve fertility for women, although it has not been used as long as embryo freezing (described above). This may be a good choice for women who do not have a partner, do not want to use donor sperm to make a fertilized embryo, or if they have a religious conflict with freezing a fertilized embryo. For egg freezing, mature eggs are removed from the female and frozen before being fertilized with sperm. This process might also be called egg banking. When the woman is ready to try to become pregnant, the eggs can then be thawed, fertilized by a partner’s or donor’s sperm, and implanted in her uterus to try to achieve pregnancy. (American Cancer Society)
Ovarian tissue freezingThis procedure is still experimental. It involves all or part of one ovary being removed by laparoscopy (a minor surgery where a thin, flexible tube is passed through a small cut near the navel to reach and look into the pelvis). The ovarian tissue is usually cut into small strips, frozen, and stored. After cancer treatment, the ovarian tissue can be thawed and placed in the pelvis (transplanted). Once the transplanted tissue starts to function again, the eggs can be collected and attempts to fertilize them can be done in the lab. Ovarian tissue removal does not usually require a hospital stay. It can be done either before or after puberty. (American Cancer Society)
Ovarian transpositionOvarian transposition means moving the ovaries away from the target zone of radiation treatment. It’s a standard option for girls or young females who are going to get pelvic radiation. It can be used either before or after puberty. This procedure can often be done as outpatient surgery and does not require staying in the hospital (unless it is being done as part of a larger operation). Surgeons will usually move the ovaries above and to the side of the central pelvic area. It’s usually best to do the procedure just before starting radiation therapy, since they tend to fall back into their normal position over time. Because of radiation scatter, ovaries are not always protected, and patients should be aware that this technique is not always successful. Costs vary based on insurance coverage. (American Cancer Society)
Fertility-sparing surgeryFor early-stage cervical cancer, the surgeon can sometimes remove the cervix (trachelectomy) without removing the entire uterus or ovaries. For early-stage ovarian cancer that only affects one ovary, the surgeon might be able to remove the one ovary that’s affected and not the other. Both of these procedures can help preserve fertility. See the images below for more information.
Ovarian SuppressionGonadotropin-releasing hormone (GnRH) agonists are long-acting hormone drugs that can be used to make a woman go into menopause for a short time. This is called ovarian suppression. The goal of this treatment is to shut down the ovaries during cancer treatment to help protect them from damaging effects. The hope is that reducing activity in the ovaries during treatment will reduce the number of eggs that are damaged, so women might be able to resume normal menstrual cycles after treatment. But, studies are not clear on the effects of this treatment as a way to preserve fertility. Experts do not recommend using ovarian suppression instead of cryopreservation or other proven fertility preservation methods. The cost for the hormone injections can be high, and the drugs can weaken bones depending on how long they are used. Because the drugs put a female into menopause, the most common side effect is hot flashes. (American Cancer Society)
Progesterone therapy for early-stage uterine cancer
Younger women sometimes have endometrial hyperplasia (pre-cancerous changes in the cells that line the uterus) or an early-stage, slow-growing cancer of the lining of the uterus (adenocarcinoma). The usual treatment would be hysterectomy (surgery to remove the uterus). However, women with stage 1, Grade 1 endometrial cancer who still want to have a child might have the option to be treated instead with the hormone progesterone, via an intrauterine device (IUD) or as a pill. Many will go on to have removal of the uterus, fallopian tubes, and both ovaries after giving birth. Since they also have a high risk of ovarian cancer, many oncologists believe young women with uterine cancer should not freeze ovarian tissue and put it back into their bodies later on. (American Cancer Society)