Fertility Preservation

Fertility preservation: Understand your options before cancer treatment

If you’re being treated for cancer, you may want to know about fertility preservation.

How does cancer treatment affect fertility?

Certain cancer treatments, like chemotherapy or radiation can affect your reproductive organs and harm your fertility or cause sterility. The effects, which may be temporary or permanent, can occur during or after treatment. Cancer treatment can affect the development of eggs, hormone levels, or the functioning of the ovaries, fallopian tubes, uterus or cervix. Women who are normally fertile after cancer treatment may experience premature menopause. The effects of chemotherapy and radiation depend on the drug or drugs and the location and dose of the radiation. The most severe damage is caused when radiation is applied to the ovaries or testicles and by chemotherapy drugs called alkylating agents. The risk of developing premature menopause after certain cancer treatments increases as you age.

When should I talk to my doctor about fertility preservation?

If you’re planning treatment for cancer and want to take steps to preserve your fertility, talk to your oncologist or a fertility specialist about your options as soon as possible. Keep in mind that for women, some methods of fertility preservation can only be done during certain phases of the menstrual cycle.

How can women preserve fertility before cancer treatment?

Women who are about to undergo cancer treatment have various options when it comes to fertility preservation. For example:
Embryo freezing
In this outpatient surgical procedure, eggs are harvested from your ovaries, fertilized through in vitro fertilization (IVF), frozen and stored. Daily injections of synthetic hormones are used to stimulate your ovaries and increase the likelihood that multiple eggs can be collected during a single cycle. The injections are typically given for up to two weeks. Eggs are removed just before ovulation with a needle inserted through the vagina into your ovary. Intravenous sedation (twilight sleep) is used during this procedure. The eggs are combined with sperm and frozen. This method of fertility preservation has the highest chance of success for women. Embryos can survive the freezing and thawing process about 65 percent of the time. However, the need to time egg retrieval can delay the start of cancer treatment by two to six weeks. This process may not be an option for women without a male partner unless they wish to use donor sperm.
Egg freezing
Similar to embryo freezing, you’ll get injections of a medication to stimulate your ovaries and then have your eggs harvested during an outpatient surgical procedure. Then your unfertilized eggs are frozen. About 70 to 80 percent of eggs survive freezing and thawing, and a similar amount will be successfully fertilized. Keep in mind that pregnancy rates might be lower when frozen eggs are used, compared with frozen embryos. This is the best option for women who do not want to create embryos, and for those without a male partner.
Ovarian transposition (oophoropexy)
During this outpatient surgical procedure — recommended if you’re having radiation applied to your pelvis and no chemotherapy — your ovaries are surgically repositioned just before radiation therapy so they’re as far away as possible from the planned radiation field. After treatment, you may need to have your ovaries repositioned again or use IVF to conceive.

Other methods of fertility preservation for women being researched include ovarian freezing — in which ovarian tissue is surgically removed, frozen and later reimplanted — and ovarian suppression before cancer therapy, in which hormonal therapies are used to suppress ovarian function and potentially protect eggs during cancer treatment.