Fertility Preservation: Consider Your Options
A diagnosis of cancer often comes unexpectedly, stirring up many challenging emotions. Typically decisions must be made expediently and treatment quickly initiated. One important consideration that should not be overlooked is future fertility. As cancer treatment continues to improve, many people can look forward to long term survival. Several cancer treatments, however, can be detrimental to fertility, including certain chemotherapy, radiation and surgery treatments.
There are several fertility preservation options that should be considered prior to initiating cancer treatment. For men, sperm banking can be done. This entails a man producing a semen sample, which is then frozen and stored for future use. It is recommended to freeze several samples, if time will allow. Later the sperm may be used with fertility treatments such as intrauterine insemination (IUI) or in-vitro fertilization (IVF).
For women, fertility preservation treatment options include:
1. Embryo Freezing: this is the most well-established option for women, offering the best chance of a future pregnancy. It requires either a male partner or donor sperm. The process is called IVF and takes approximately 2-3 weeks to complete. Hormones will be taken that will stimulate the ovaries to produce multiple eggs; once mature, the eggs will be removed from the body through an egg retrieval procedure and put together with sperm in the lab to create embryos. These embryos are frozen and will be available for future use. If there is a heritable cancer present (e.g. BRCA gene), the embryos can be tested with pre-implantation genetic diagnosis (PGD) to determine if they have that gene. When ready to conceive, the embryo(s) will be transferred back into the patient, or into a gestational surrogate if there is a contraindication to carrying a pregnancy.
2. Egg (Oocyte) Freezing: this option may be selected if a woman has no current male partner or for other personal reasons. While the technology has greatly improved for freezing eggs (vitrification), pregnancy rates do remain higher per frozen embryo than per frozen egg. This is because the egg still must go through the fertilization process and develop as an embryo, whereas the frozen embryo has already gone through this development. Once ready to conceive, the eggs will be thawed and fertilized with partner or donor sperm. Finally, the embryo(s) will be transferred into the uterus.
3. Ovarian Tissue Freezing: this treatment is considered experimental and involves surgery to remove tissue from the ovaries. The tissue is divided into strips and frozen. When ready, the tissue can be thawed and placed back into the body to try and produce an egg. This is currently the only option for pre-pubertal girls.
Questions to ask your doctor:
Will my cancer treatment affect my future fertility? Will these changes be temporary or permanent?
Before starting my cancer treatment, is there anything that can be done to increase my chances of having children in the future?
I am interested in freezing eggs/sperm or embryos. Can you please give me more information and refer me to a fertility specialist?
For how long during and after cancer treatment should I avoid getting pregnant? What is the best birth control option for me?