However, studies show that the majority of oncologists do not discuss fertility routinely with their at-risk patients. If you're facing cancer, ask your health care team for fertility preservation information as soon as you can so that you will have access to the full range of preservation options.
Questions to Ask Yourself
- Have I always wanted children?
- Would I prefer adoption to other parenthood options?
- Does it matter to me if my children are biologically related to me?
- Am I open to using donor sperm or donor embryos?
- How many children do I want to have?
- How does my partner/spouse feel about all of these issues?
- Do I have ethical or religious concerns about assisted reproductive technologies?
If you learn that you are at risk for infertility from cancer treatment, it's important to take the time to think about the significance of parenting to you. Consider whether you want to be a parent some day. If so, think about whether having a child genetically related to you is important. Understanding how you feel about parenthood will help you decide whether to pursue preservation options presented in this article.
There are several fertility preservation options that women should consider before, during and after cancer treatment. Some options may minimize damage to your reproductive system and/or preserve your eggs.
Egg and Embryo Freezing
Egg and embryo freezing are the two most common ways women can preserve their fertility before cancer treatment.
Egg freezing may be an option prior to cancer treatment for you if you do not have a male partner, do not want to use donor sperm or do not want to pursue embryo freezing. Egg freezing may also be an option after treatment for women who are still fertile but at risk for early menopause. The process is considered a standard, outpatient procedure and takes approximately two weeks from the start of the menstrual cycle, and the entire process takes between two and six weeks.
First, the ovaries are stimulated to mature multiple eggs. Doctors then remove the mature eggs and freeze them for future use. Egg freezing costs approximately $11,900 per cycle, plus $300–$500 per year for storage, and has a success rate of 36–61 percent per transfer. This process has resulted in more than 1,000 live births. Your physician's clinical experience with this technique is an important consideration when exploring egg freezing.
Embryo freezing is the most established way to preserve a woman’s possibility of fertility prior to cancer treatment and requires a male partner or donor sperm. It may be an option for you if you are post treatment and still fertile but at risk for early menopause. Freezing embryos takes approximately two weeks from the start of the menstrual cycle, and the entire process takes between two and six weeks and is a standard, outpatient procedure.
First, the ovaries are stimulated to mature multiple eggs. Doctors remove the mature eggs and fertilize them in the lab with sperm from a partner or donor to create embryos via in vitro fertilization (IVF). Embryos are then frozen for future use. Embryo freezing costs approximately $12,400 per cycle of IVF, plus $400–$600 per year for storage. This option has a success rate of 30–40 percent, though it varies by maternal age and reproductive center. This process has has helped to create thousands of live births every year.
Ovarian Tissue Freezing
This is currently an experimental, outpatient surgical procedure to remove ovarian tissue (complete or partial ovary). Removed tissue that contains hormone-producing cells and immature eggs is divided into strips and frozen for future use through re-implantation or in vitro maturation of eggs.
Removal of ovarian tissue is generally done before treatment but can be done after treatment if you are still fertile and at risk for early menopause. However, ovarian tissue freezing is not suitable for you if you are at high risk for ovarian metastases.
Ovarian tissue freezing the only fertility preservation option for pre-pubescent girls.
The cost is approximately $10,000 for surgery, plus $300–$500 per year for storage, though costs may be reduced or waived due to the experimental nature of the procedure. To date, this procedure has resulted in approximately 28 live births worldwide.
In this process, ovaries are surgically moved higher in the abdomen and away from the radiation field to minimize exposure and damage prior to radiation treatment. This fertility preservation option has a 79–100 percent success rate of protecting ovarian function from the effects of pelvic radiation; however, it does not protect against chemotherapy. The cost is unknown, and it may be covered by insurance.
Gonadotropin releasing hormone (GnRH) analog treatments are used to cause the ovaries to temporarily shut down, placing patients in a menopausal state during chemotherapy. Ovarian suppression is an experimental technique done through monthly injections, ideally beginning two-four weeks before chemotherapy. The success rate ovarian suppression is unknown and costs $500 per month. This method does not protect against the effects of radiation. It is most commonly used by young breast cancer patients who are risk for early menopause.
This fertility-sparing technique involves removal of the cervix while preserving the uterus for early stage cervical cancer patients. Fertility remains unaffected; however, if you use this technique your risk for pre-term birth is elevated and pregnancies are considered high-risk. The cost is generally included in the cost of cancer treatment, but radical trachelectomy is only available at a limited number of cancer centers. If you are considering radical trachelectomy, you should evaluate your health care provider's surgical expertise using this technique.