Fertility Preservation for Women

This article may be useful for people born with ovaries and a uterus.

Cancer treatments can affect your ability to become pregnant and have a child. This is called fertility. If you are interested in having a child in the future, you should talk with your care team about your options for fertility preservation (ways to try to preserve or keep the option of having a child in the future). Preserving your fertility can take time, which may delay the start of treatment. When it is important to start treatment quickly, options for fertility preservation may be limited. It is important to have an open and honest talk with your care team about your wishes and options. Options for fertility preservation for women include:

Egg or Embryo Cryopreservation

• Cryopreservation is the collection and freezing of eggs for use at a later time.
• Embryo cryopreservation is the freezing of an embryo, which is a fertilized egg.

Cryopreservation of eggs or embryos uses the same collection process, which can take 2-4 weeks. Fertility-stimulating medicines are used to make the body release many mature oocytes. These can then be collected.

Cryopreservation of eggs does not need sperm because these eggs are frozen unfertilized. Unfertilized eggs are more sensitive to the freezing process because they contain water that can form ice crystals and cause damage. A method of freezing called vitrification has made the process more successful in recent years. Some centers report the same success rates with egg freezing as with embryo freezing.

For embryo cryopreservation, the egg must be fertilized with sperm. This can be sperm from a partner or donor.

Oophoropexy (Ovarian Transposition)

Oophoropexy is a surgery done to move one or both ovaries and fallopian tubes to a different part of the abdomen (belly). This is done to lessen the ovaries' exposure to pelvic radiation. This is often done along with surgery to treat the cancer but can be done laparoscopically (small cuts/incisions) if you do not need other surgery. Women have been able to conceive after this procedure, but in some cases, a second procedure is needed to return the ovary to its normal place, especially if in-vitro fertilization is needed. The cost of oophoropexy can vary depending on the surgery or procedure used.

Ovarian Tissue Freezing

Using laparoscopic surgery, all or part of one ovary is taken out before your treatment starts. The outer surface of the ovary contains the eggs, and this area is frozen for future use.

There are many ways to use this tissue. Ovarian tissue can be implanted back into you (called auto-transplant), either orthotopically (in the same location it was taken from) or heterotopically (in a different location, for example, the forearm). After implantation, the tissue matures, and oocytes can be collected and used through in-vitro fertilization procedures.

A number of pregnancies have come from using frozen tissue, but this technique is still rather new. It is not an option for some types of cancer, including leukemias, due to the risk of the cancer being present in the tissue.

Radical Trachelectomy & Conservative Surgery

Radical trachelectomy is a procedure used in the treatment of cervical cancer. Trachelectomy removes the cervix but leaves the uterus intact. You will need cerclage to carry a pregnancy (a technique to stitch the uterus closed to prevent premature birth or miscarriage). There is still a risk of premature deliveries or late miscarriages. You may need IVF because of trouble getting pregnant due to the lack of a cervix. These pregnancies are thought to be high-risk and will need a C-section for delivery due to the cerclage and the lack of a cervix.

There are other types of conservative surgeries that can be used for certain types and stages of gynecological cancers. Speak to your surgeon about what options you have for preserving fertility.

Ovarian Suppression

Ovarian suppression works on the theory that the cells in the ovaries are harmed by chemotherapy because they are quickly dividing and reproducing. By giving medication that temporarily shuts down the ovaries, they might be protected from the damage of chemotherapy. This can be done with long-acting hormone medications called gonadotropin-releasing hormone (GnRH) agonists.

Paying for Fertility Preservation

Fertility-preserving techniques for women can come at a major cost. Some insurance plans may cover some of the costs of fertility preservation. The National Infertility Association provides up-to-date information on financial assistance resources. Talk to your insurance company or your employer's human resource representatives to explore what is covered.

You can learn more about how your treatments can affect your fertility and find links to resources for more information.