Fertility Preservation Before Cancer Treatments
Fertility preservation before cancer treatments at a glance
- Fertility preservation procedures (sometimes called oncofertility) are performed before cancer treatments (which can impair or end fertility) so that the woman can conceive after treatment.
- Cancer treatments that compromise fertility include radiation, chemotherapy and surgery to remove reproductive organs.
- The likelihood of fertility impairment depends on the type of cancer and the woman’s age, and the effects can be permanent or temporary.
- Fertility preservation methods may involve egg or embryo freezing (cryopreservation) or physically moving reproductive organs in the body to protect them from radiation.
- Most research suggests that the fertility preservation methods do not affect a woman’s ability to fight cancer.
- Sometimes cancer treatment must be delayed in order to complete fertility preservation procedures.
Fertility preservation options before cancer treatments
A woman diagnosed with gynecological cancer may consider undergoing fertility preservation procedures before her cancer treatment if she still intends to bear children. Cancer treatments — radiation, chemotherapy and surgery to remove reproductive organs, for example — can reduce or end a woman’s fertility.
The chance of fertility damage from cancer treatments depends on the type of cancer, the stage of its progression and the patient’s age, as this naturally decreases a woman’s fertility. The patient’s fertility may be impaired at the time of treatment or afterward. The effects can be permanent or temporary.
Cancer treatments affect fertility in several ways.
- Strong chemotherapy drugs and radiation can cause damage
- Egg quality and hormone levels critical for reproduction may be affected, as well as the ovaries, uterus and cervix
- Removal of the uterus or ovaries ends fertility
- Older women may experience more ovarian damage than younger women.
The most important consideration of fertility preservation methods is balancing the desire to preserve a woman’s fertility with saving her life by not delaying cancer treatments too long.
Research reveals no evidence that the actual fertility preservation methods themselves directly affect the overall success of cancer treatments. As long as cancer treatments don’t expose fetuses, the cancer treatments themselves will not affect the health of unborn babies.
There is some growing evidence that suggests ovarian stimulation may harm women with certain hormone-sensitive breast cancers. But more evidence and research is currently needed before confirming this cause and effect.
Fertility preservation procedures
Young girls and women who would like to have children someday may consider one of the following methods to give themselves the best shot at building a family.
- Embryo freezing – The most common and successful method, this procedure involves harvesting a woman’s eggs, fertilizing them with sperm using in vitro fertilization (IVF), then freezing and storing them (cryopreservation) until a woman’s cancer treatment is completed and she would like to try get pregnant by implanting her thawed, frozen embryo.
- Egg freezing – This method is similar to embryo freezing, with the woman’s eggs being removed, frozen and stored for future fertilization and embryo implant through IVF.
- Ovarian transposition – This procedure is deployed when radiation is used on the pelvis without chemotherapy, and involves surgically repositioning the ovaries as far away from the radiation field as possible. Typically, the ovaries are returned to their normal position after radiation in order for the woman to conceive.
- Gonadal shielding – Shields are specifically placed to protect reproductive organs from radiation exposure. This is also only used when chemotherapy is not included in the cancer treatment because the chemotherapy may damage the organs even with shields in place.
- Radical trachelectomy – This cancer treatment removes a woman’s cervix, lymph nodes in the pelvis and the top part of the vagina, but preserves the ability to bear children. This is an alternative to a hysterectomy, which ends a woman’s fertility by removing her reproductive organs.
Most fertility preserving techniques address non-aggressive cancers. Some experimental procedures, such as ovarian tissue cryopreservation, may be used by women with no other option to save their fertility. It is also used for girls who have not begun puberty and started ovulating to produce eggs that could be frozen. The procedure surgically removes ovarian tissue, freezes the tissue, then after cancer treatment re-implants the tissue near the fallopian tube where it can produce new eggs.