What are the options for fertility preservation after a cancer diagnosis? Receiving a cancer diagnosis is extremely challenging, and usually requires urgent treatment. While navigating the emotional, physical, and logistical challenges of cancer treatments, patients may not realize the effects their treatments can have on future fertility. There are several options for fertility preservation for patients with cancer.
How Can Cancer and Cancer Treatments Affect Fertility?
Certain cancers can directly affect fertility by damaging reproductive organs, including the ovaries, uterus, cervix, and testes. In some cases, the affected organs may need to be surgically removed. Even if the cancer itself does not affect those organs, treatments including chemotherapy and radiation can damage reproductive organs.
When Is Fertility Preservation Important?
Patients have the most options for fertility preservation before starting treatment of any kind. Certain fertility preservation methods must line up with your menstrual cycle, which can affect the timing of beginning treatment. At the same time, different diagnoses can require more urgent treatment. For this reason, it’s important to talk with your care team as soon as possible about fertility preservation if you might wish to have children in the future
Your doctor may not bring it up on their own. Unfortunately, many patients treated for cancer say they never received information of the potential effect of treatments on their fertility. If fertility preservation is important to you, make sure to discuss timing and options with your care team, to try to get a fertility consultation as soon as possible.
Fertility Preservation for People With Ovaries After a Cancer Diagnosis
Fertility preservation for people with ovaries falls into two broad categories:
1) attempting to minimize the effects of treatment on the reproductive system
2) cryopreserving (freezing) reproductive tissue for future use
The first option involves “fertility-sparing” treatments. These might include moving the ovaries or uterus aside to try to shield them from the effects of radiation, or removing only portions of affected organs. These methods have varying degrees of success.
The second option involves taking reproductive tissue, then freezing and storing it to use later in life. In this case, even if the ovaries suffer damage during treatment, the patient may still be able to become pregnant through in vitro fertilization (IVF). This form of fertility preservation includes:
Egg freezing – the patient takes hormonal medications to boost egg production. A doctor removes these eggs from the ovaries; they are then frozen in a lab, to later be thawed and fertilized via IVF to develop into an embryo, which is then transferred to the uterus.
Embryo freezing – this involves the same egg development and retrieval as egg freezing. However, the retrieved eggs are fertilized via IVF (using either a partner’s or donor sperm) before freezing.
Ovarian tissue freezing – all or part of an ovary is removed, divided into sections, and frozen. Later, the tissue is thawed and replaced into the pelvis, where it may start to function again and produce eggs to be retrieved for IVF. Freezing ovarian tissue is the only fertility preservation option available for children with ovaries who have not yet gone through puberty. As of December 2019, the American Society for Reproductive Medicine (ASRM) no longer considers ovarian tissue cryopreservation to be an experimental treatment. Ovarian tissue freezing is not available at Pacific NW Fertility at this time.
Fertility Preservation for People With Testes After a Cancer Diagnosis
Currently, the only proven method of fertility preservation is sperm cryopreservation, or sperm freezing. This process is fairly simple; patients provide a sperm sample, usually in a private room at a clinic or laboratory. The lab then freezes and stores the sperm sample, to later thaw and use via IVF.
Unfortunately, sperm preservation only works for patients past puberty. For children with testes who have not yet gone through puberty, there is an experimental option that involves removing and freezing testicular tissue, to later thaw and replace into the patient’s pelvis. While the process is similar to ovarian tissue freezing, there is not yet enough data to show whether testicular tissue freezing is an effective option for fertility preservation. Testicular tissue freezing is not available at Pacific NW Fertility at this time.
Navigating a recent cancer diagnosis can be overwhelming. We created our Center for Fertility Preservation, led by Dr. Julie Lamb, to help patients explore and understand their options. We’ll work with you to create a personalized fertility preservation plan, while our financial counselors can provide resources on insurance coverage and other payment options. Afterwards, we’ll coordinate care with your oncology team.
If you are curious about options for you at Pacific NW Fertility – call us today. We can connect you with a knowledgeable team member who can answer your questions right away.
Additional Reading:
Fertility preservation before cancer treatment — American Society of Reproductive Medicine (ASRM)
American Cancer Society resource on fertility and cancer treatments for women with cancer
American Cancer Society resource on fertility and cancer treatments for men with cancer
