Women's options before cancer treatment

Sunday 1 May, 2016

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On this page: Options for preserving fertility | How in-vitro fertilisation (IVF) worksKey points

Related Pages: Women's fertility and cancer treatment | Women's options after cancer treatment


This section has information about ways a woman can preserve her fertility before starting cancer treatment. It’s ideal to discuss your options with your cancer or fertility specialist at this time. See talking about fertility for information.

Ask your cancer specialists how long you have to consider your options. In many cases, you can wait a week or two before starting treatment. Be sure to understand the risks of each fertility option and keep in mind that no method works all of the time.

If you didn’t have an opportunity to discuss your options before cancer treatment, you can still consider your fertility later, but there may not be as many choices available. See women’s options after cancer treatment for details.

Options for preserving fertility

Wait and see
What this is

When no methods are used to preserve fertility.

When this is used

When a woman decides to leave her future fertility to chance.

How this works

Requires no action.

Special considerations

Not known.

Pregnancy rate

Depending on age and cancer treatment.

Egg or embryo freezing (cryopreservation)
What this is

The process of collecting, developing and freezing eggs or embryos as part of an in-vitro fertilisation (IVF) cycle.

When this is used

When you want to store eggs or embryos for the future. They can be stored for many years. In some states of Australia, you will need to apply for an extension after eggs have been frozen for 20 years and embryos for 10 years.

If you have frozen eggs, embryos or ovarian tissue, check the time limits with the fertility centre, pay any annual fees and keep your contact details up to date.

Once you are ready to have a child, the frozen sample is sent to your fertility specialist.

How this works

Egg and embryo freezing is part of IVF – the most common and successful method for preserving a woman’s fertility. See below for a diagram of the IVF process.

The cycle starts with your period, and you have an egg collection mid-cycle, usually around day 14. This is a minor procedure in an operating theatre.

Special considerations

Your specialists will plan to delay cancer treatment or stop it during IVF.

Some women with advanced or hormone-sensitive cancer risk their cancer growing during hormone stimulation. In this case, tamoxifen, or more commonly, letrozole (anti-oestrogen drugs) may be used to prevent cancer growth. It may also be possible to skip hormone stimulation and collect a few eggs during the woman’s natural ovulation cycle or early in a cycle (in-vitro maturation of oocytes). More research is being done, so talk to a fertility specialist.

Pregnancy rate

Depending on your age, the success rate of the fertility unit, and the stage the embryos are stored at, there may be up to a 25–40% chance per cycle of an embryo developing into a pregnancy. About 10–12 mature eggs are collected during a cycle and these create an average of up to 4 embryos. Many thousands of babies have been born from mature eggs that have been frozen, and millions of babies have been born from frozen embryos. A modern technique called vitrification means that freezing eggs is equally as effective as freezing embryos. Some women prefer to freeze eggs, particularly as partners may change.

Ovarian tissue freezing (cryopreservation)
What this is

The process of removing, slicing and freezing a piece of tissue from the ovary.

When this is used

If there isn’t a lot of time before treatment, if hormone stimulation is unsafe, or if the patient hasn’t gone through puberty.

How this works

Tissue is removed during keyhole surgery (laparoscopy). Under general anaesthetic, a small cut is made near the bellybutton to access the pelvic area. If you are having pelvic or abdominal surgery as part of your cancer treatment, it can be done during this procedure. Tissue is frozen until needed. When you are ready to conceive, the ovarian tissue slices are transplanted (grafted) back into your body. Tissue can start to produce hormones, and eggs can develop.

Special considerations

The grafts may last a relatively short time (several months to several years), so this option is usually only suitable if you are ready to try for a pregnancy soon.

Pregnancy rate

To date, over 40 births worldwide.

Ovarian transposition (oophoropexy)
What this is

A type of fertility-sparing surgery. It involves moving one or both ovaries to preserve their function.

When this is used

When the ovaries are in the path of radiotherapy treatment.

How this works

One or both of the ovaries are moved higher in the abdomen – sometimes as high as the lowest ribs.

Special considerations

Not known. May cut off blood supply to the ovaries, causing loss of function.

Pregnancy rate

Depends on your age, the amount of radiation that reaches the ovaries in the new position and if you start menstruating again.

Trachelectomy
What this is

A type of fertility-sparing surgery. It involves removing the cervix, upper part of the vagina and lymph nodes in the pelvis to preserve reproductive organs.

When this is used

For small, localised tumours in the cervix.

How this works

The cervix is removed. The uterus is left in place. A stitch or band is used to partially close the uterus and work as the cervix. This opening is used for menstruation and for sperm to enter.

Special considerations

Mid-trimester miscarriage and premature delivery are more common. Women may be advised to have a stitch placed in the cervix to reduce miscarriage.

Pregnancy rate

Possible to become pregnant after a trachelectomy.

GnRH analogue treatment
What this is

Gonadotropin-releasing hormones (GnRH) are long-acting hormones used to cause temporary menopause. Reducing activity in the ovaries may protect eggs from being damaged.

When this is used

During chemotherapy or pelvic radiotherapy.

How this works

Hormones are given by injection 7–10 days before cancer treatment starts or within the first week of treatment. Injections continue every 1–3 months until cancer treatment has finished.

Special considerations

May be recommended as a backup to other fertility options, such as egg or embryo cryopreservation, or as the only form of infertility protection.

Pregnancy rate

Some studies suggest this treatment helps women under 35 but results are not yet clear.

How in-vitro fertilisation (IVF) works

  1. Hormone injections to help stimulate your body to produce eggs.
  2. Mature egg/s are collected from the follicle using a needle guided by ultrasound.
  3. The eggs are combined with sperm from a partner or donor, or frozen for later use.
  4. Fertilised eggs may divide and form embryos. Embryos can also be frozen for later use.
  5. A syringe is used to implant embryos into your body (or a surrogate). This will usually be after cancer treatment.

Key points

  • In-vitro fertilisation (IVF) uses hormone stimulation to develop eggs, which are collected, fertilised (if possible) and frozen.
  • Ovarian tissue is removed and frozen until needed, then it’s re-implanted.
  • Some operations will spare your reproductive organs.
  • Hormone treatments, known as ovarian suppression, could preserve your fertility

Reviewed by: Prof Roger Hart, Medical Director of Fertility Specialists of Western Australia and Professor of Reproductive Medicine, School of Women’s and Infant Health, University of Western Australia, WA; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s and Prince of Wales Hospitals, Director of the Sydney Youth Cancer Service, NSW; Brenda Kirkwood, 13 11 20 Consultant, Cancer Council Queensland, QLD; Dr Michael McEvoy, Director of Clinical Services, Flinders Fertility, SA; Eden Robertson, Research Officer, Behavioural Sciences Unit, Sydney Children’s Hospital, NSW; Kayla Schmidt, Consumer; A/Prof Kate Stern, Head of Fertility Preservation Service, The Royal Women’s Hospital and Melbourne IVF, Head Endocrine and Metabolic Service, Royal Women’s Hospital and Clinical Director, Melbourne IVF, VIC; and Prof Jane Ussher, Centre for Health Research, Western Sydney University, NSW.
Updated: 01 May, 2016