What is medical fertility preservation?

Certain conditions including cancer and its treatment may affect fertility. Medical fertility preservation includes measures taken to help people affected by such conditions have their own genetic children in the future.

Dealing with cancer is difficult and thinking of future children after cancer can be overwhelming but it is an important consideration given that cancer is often curable with the latest available treatments. Before undergoing treatment for cancer, your doctor will discuss the risks of treatment including infertility and will recommend speaking with a fertility specialist.

What are the cancer treatments that affect fertility?

Radiotherapy or chemotherapy for cancer can cause damage to ovaries or testes which produce eggs and sperm respectively. Radiotherapy can also cause damage to the uterus. Surgery for cancer treatment may involve removal of the reproductive organs or structures of the reproductive tract. Cancer treatment may affect the ovaries in the following ways:

• Temporary failure of ovarian function with lack of menstrual periods that usually returns to normal in 3-12 months
• Permanent ovarian failure, a less common condition due to high-dose treatments
• Delayed ovarian failure and infertility, with onset a few years after treatment

As women age they have fewer eggs, so the risk of infertility following cancer treatment is higher in older women.

What are the available fertility preservation methods?

There are a variety of fertility preservation techniques such as:

• Medicines to protect the ovaries
• Freezing of eggs, embryos and ovarian tissue
• Freezing of sperm, semen and testicular tissue

Your doctor will evaluate the extent of your cancer and the amount of time you have before starting cancer treatment to determine the best fertility preservation option for you.

How can the ovaries be protected during chemotherapy?

To protect your ovaries during chemotherapy, your doctor may recommend a GnRH analogue, a medication that suppresses ovarian function temporarily during cancer treatment. This prevents eggs from maturing and getting damaged by chemotherapy. You will receive monthly injections along with your chemotherapy drugs. Side effects may include temporary hot flushes.

How are eggs, embryos and ovarian tissue preserved?

If you have enough time before cancer treatment begins, your doctor may prescribe hormonal medications for about 10-12 days to help you mature and release multiple eggs. About 10-20 eggs are collected during a minor procedure performed through the vagina. The eggs may be frozen as such or fertilized with your partner’s sperm or sperm from a donor and then frozen. Frozen eggs and embryos have a high degree of viability once thawed, and a significant percentage result in live births.

A newer technique involves obtaining a small amount of ovarian tissue before beginning high-dose treatment that may permanently affect ovarian function or when there is little time for hormone stimulation. This is performed with a minimally invasive laparoscopic procedure. When the woman wants to have a child, the ovarian tissue is grafted and eggs are produced.

What if you were not able to save your eggs or ovarian tissue?

Women who did not or could not undergo fertility preservation, those who were unsuccessful with the procedure and those unable to carry a child for various reasons can still have children through donated eggs or surrogacy.