Oncofertility/
Fertility Preservation

Cancer treatments such as chemotherapy and radiation can impact a woman’s ovarian reserve and a male’s testicular function and, as a result, the likelihood of conceiving spontaneously in the future.

For women, certain types of chemotherapy or radiation therapy can affect menstrual cycle regularity and can cause amenorrhea (cycles to stop for a period of time). Periods may continue or return after treatment, but having periods does not always equate to fertility. In some cases periods may never return.

Chemotherapy or radiation therapy can cause infertility immediately or years after treatment by causing early menopause. Cancer treatment may also affect the ability to carry a pregnancy. For instance, high-dose radiation to the pelvic region can raise the risk of a future miscarriage or cause premature birth. Women who have had a hysterectomy (surgery that removes the uterus) cannot carry a child.

Not everyone becomes infertile after cancer treatment. The impact that cancer treatment may have on your fertility depends on many factors, including:

• The type of cancer and stage
• Type and total dose of chemotherapy
• Location and dose of radiation therapy
• Location of surgery
• Your age at the time of your treatment
• Your baseline fertility before you start treatment

Ideally, most fertility-preserving procedures need to be done before your cancer treatment begins. The options available to you depend on several factors, including:

• Age
• Relationship status, such as whether you have a partner who could provide sperm
• How physically and sexually mature you are
• Your feelings about specific procedures
• Your comfort with alternative options in the future such as adoption and egg, sperm, or embryo donation

Our experts can help you explore options to preserve your fertility which may include:

This procedure is similar to embryo freezing, except that the eggs are frozen without being fertilized by sperm. This procedure may pose fewer practical issues than freezing embryos because a male partner is not needed.

Some types of surgery for cervical or ovarian cancer can treat the cancer and help you maintain your fertility.

Radiation treatment to both ovaries causes infertility. You may be able to get radiation to only one ovary to preserve your fertility. Another option is a procedure called oophoropexy. In this procedure, one or both of your ovaries are moved where radiation treatment won’t reach them. Then, they are returned after treatment. This method isn’t always successful. Radiation isn’t precise and may reach the ovaries or the ovarian blood supply, even if they are moved.

This investigational procedure involves taking hormones that suppress ovarian function to protect eggs from treatment. The procedure’s effectiveness has not yet been shown and is generally not recommended as a reliable method of fertility preservation.

This investigational procedure requires the surgical removal and freezing of ovarian tissue. Then, this tissue is transplanted back into your body after your cancer treatment is complete. This may be the only option for young girls who cannot undergo oocyte or embryo freezing because of lack of time or sexual immaturity. Even though many pregnancies have occurred with this technique, it is too early to evaluate its success rates.

If you are facing cancer treatment and want to preserve your fertility options, consider asking your doctor or another member of your health care team the following questions before treatment begins:

• What is the risk of infertility from the recommended treatments for my cancer?
• What options do I have to preserve my fertility?
• How can I find out my baseline fertility status?
• Will any of these options postpone the start of my treatment? If so, what effect could this delay have on my chance of recovery?
• Will any of these fertility preservation options increase the risk that the cancer may come back?
• Should I talk with a fertility specialist or a reproductive endocrinologist before starting treatment?
• Are there any resources for support?
• How will I know if I am fertile after cancer treatment?
• What is the cost of fertility preservation?
• Are there other options to have a family if I don’t elect to have fertility preservation treatment and my fertility is affected?