Female Fertility Preservation

This article may be useful if you were born with female reproductive organs (ovaries, a uterus, fallopian tubes, cervix).

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 individuals born with female reproductive organs include:

Egg or Embryo Cryopreservation

• Cryopreservation is the collection and freezing of eggs for use at a later time.
  • Cryopreservation of eggs or embryos uses the same collection process, which can take 2-3 weeks. Fertility-stimulating medicines are used to make the body release many mature oocytes (eggs). These can then be collected.
  • Cryopreservation of eggs does not need sperm because these eggs are frozen unfertilized. Egg retrieval is the standard of care, with some centers reporting the same success rates with egg freezing as with embryo freezing.
• Embryo cryopreservation is the freezing of an embryo, which is a fertilized egg.
  • 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. 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), which is most common and successful at achieving pregnancy, or heterotopically (in a different location, for example, the forearm), which is most commonly used to restore hormone function. After implantation, the tissue matures, and oocytes can be collected and used through in vitro fertilization procedures.

Ovarian tissue cryopreservation (OTC) is a method of fertility preservation, especially if you haven’t gone through puberty or if you cannot delay cancer treatment for ovarian stimulation.  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 used to treat cervical cancer. Trachelectomy removes the cervix but leaves the uterus intact. You will need cerclage (a technique to stitch the uterus closed to prevent premature birth or miscarriage) to carry a pregnancy. There is still a risk of premature deliveries or late miscarriages. 

You may need IVF because of trouble getting pregnant due to cervical stenosis (narrowing of the cervix), leading to difficulty conceiving naturally or issues with menstruation. 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. Talk to your provider about what options you have for preserving fertility.

Ovarian Suppression

Ovarian suppression is based on the idea that 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. Ovarian suppression may be a good option, but it may not work as well as freezing your eggs.

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. RESOLVE: The National Infertility Association provides up-to-date information on financial assistance resources (https://resolve.org/learn/financial-resources/). Talk to your insurance company or your employer's human resources representatives to learn more about what may be covered.

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