Fertility after Cancer: Survivorship
Today young adult survivors of cancer and other diseases are looking forward to a future of long term survival due to improved treatments. However, many of the therapies that have so effectively helped increase survival have side effects that may cause the loss of fertility.
New reproductive technologies are providing possibilities for preserving fertility in survivors of cancer and other diseases, yet many patients are unaware of these options.
In most cases, decisions on fertility preservation need to be made before treatment begins. Reproductive specialists and patient navigators are working with physicians from clinical centers such as the Columbia University Cancer Center to help patients explore the issues surrounding fertility preservation. Your treatment team can help you understand the options available, assess risks and eligibility, and provide referrals to individuals who are experts in this field.
Available Fertility Preservation Options
Each patient is unique. The impact of a given treatment on fertility can vary and so can the time available before starting life saving cancer treatments. Fertility preservation treatments must be tailored to the individual circumstances and integrated with the treatment regimen. Close coordination between the treating physician and the reproductive endocrinologist is the key to preserving family-building options for patients.
Embryo banking
During this process, a woman’s ovaries are first stimulated to mature multiple eggs, which are then removed and fertilized through in vitro fertilization (IVF) with sperm to create embryos. The embryos are then frozen for future use. The entire process can take up to one month.
Egg banking/freezing
This relatively new technology, according to the American Society for Reproductive Medicine, is no longer considered experimental. This process is exactly the same as described for embryo banking except that the eggs are NOT fertilized before freezing. This is a good option for single women who do not have a male partner and do not want to use donor sperm. The entire process can take up to one month.
Ovarian tissue banking
One entire ovary is removed surgically and the outer surface (cortex) which contains the eggs is frozen in strips for later use. Women who are survivors of some types of cancer can have pieces of the tissue thawed and transplanted back. A number of pregnancies have resulted from using this technique. Transplant is not safe following some types of cancer (e.g. leukemia) because of the risk of re-seeding the original cancer. The Oncofertility Consortium® is actively researching new ways to use this tissue. New techniques are still experimental but may be the best option for woman who must start their treatments immediately.
Ovarian transposition
Surgeons can move the ovaries away from the area receiving radiation therapy. The goal of the surgery is to move the ovaries within the pelvis where they can still function, but will be out of the way of harmful radiation. This technique will not protect against the effects of chemotherapy.
(The procedures listed above have varying risks and side effects. Some options may not be recommended for certain types of cancer or disease. There may also be treatments available that have a smaller risk of infertility. It is important to discuss these procedures with your physician and your insurance provider since they may be expensive and not covered by insurance.)
Additional Options
SaveMyFertility.org
Learn more about the fertility and hormonal risks of cancer and treatment options for women at SaveMyFertility.org and download a free iphone app on cancer and fertility.
Today young adult survivors of cancer and other diseases are looking forward to a future of long term survival due to improved treatments. However, many of the therapies that have so effectively helped increase survival have side effects that may cause the loss of fertility.
- For women, certain therapies can cause ovarian damage or failure, early menopause, genetic damage to growing eggs and other reproductive problems.
- For men, treatments can cause damage to the testes and interfere with sperm production.
New reproductive technologies are providing possibilities for preserving fertility in survivors of cancer and other diseases, yet many patients are unaware of these options.
In most cases, decisions on fertility preservation need to be made before treatment begins. Reproductive specialists and patient navigators are working with physicians from clinical centers such as the Columbia University Cancer Center to help patients explore the issues surrounding fertility preservation. Your treatment team can help you understand the options available, assess risks and eligibility, and provide referrals to individuals who are experts in this field.
Available Fertility Preservation Options
Each patient is unique. The impact of a given treatment on fertility can vary and so can the time available before starting life saving cancer treatments. Fertility preservation treatments must be tailored to the individual circumstances and integrated with the treatment regimen. Close coordination between the treating physician and the reproductive endocrinologist is the key to preserving family-building options for patients.
Embryo banking
During this process, a woman’s ovaries are first stimulated to mature multiple eggs, which are then removed and fertilized through in vitro fertilization (IVF) with sperm to create embryos. The embryos are then frozen for future use. The entire process can take up to one month.
Egg banking/freezing
This relatively new technology, according to the American Society for Reproductive Medicine, is no longer considered experimental. This process is exactly the same as described for embryo banking except that the eggs are NOT fertilized before freezing. This is a good option for single women who do not have a male partner and do not want to use donor sperm. The entire process can take up to one month.
Ovarian tissue banking
One entire ovary is removed surgically and the outer surface (cortex) which contains the eggs is frozen in strips for later use. Women who are survivors of some types of cancer can have pieces of the tissue thawed and transplanted back. A number of pregnancies have resulted from using this technique. Transplant is not safe following some types of cancer (e.g. leukemia) because of the risk of re-seeding the original cancer. The Oncofertility Consortium® is actively researching new ways to use this tissue. New techniques are still experimental but may be the best option for woman who must start their treatments immediately.
Ovarian transposition
Surgeons can move the ovaries away from the area receiving radiation therapy. The goal of the surgery is to move the ovaries within the pelvis where they can still function, but will be out of the way of harmful radiation. This technique will not protect against the effects of chemotherapy.
(The procedures listed above have varying risks and side effects. Some options may not be recommended for certain types of cancer or disease. There may also be treatments available that have a smaller risk of infertility. It is important to discuss these procedures with your physician and your insurance provider since they may be expensive and not covered by insurance.)
Additional Options
- Donor Egg is recommended when the ovaries are permanently damaged by cancer treatment and no longer able to produce eggs. A known or anonymous egg donor is hormonally stimulated to mature multiple eggs that can be harvested and fertilized with sperm from the patient’s male partner to form embryos. The embryos can then be transferred into the patient’s own uterus to carry the pregnancy.
- Donor Sperm is recommended when the testes are permanently damaged by cancer treatment and no longer able to produce sperm. The sperm from a known or anonymous donor is used to achieve a pregnancy with the patient’s female partner.
- Gestational Surrogate is required when cancer treatment damages the uterus and prevents a woman from carrying a pregnancy. Embryos created from a couple’s eggs and sperm are transferred into the uterus of the gestational surrogate in order to carry the pregnancy.
- Adoption is a legal transfer of all parental rights and responsibilities of a child from the biological parent.
SaveMyFertility.org
Learn more about the fertility and hormonal risks of cancer and treatment options for women at SaveMyFertility.org and download a free iphone app on cancer and fertility.
