Women's options before cancer treatment

Sunday 1 June, 2014

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On this page: Embryo development and freezing (cryopreservation) | Ovarian tissue freezing (cryopreservation) | Fertility-sparing surgery | Using hormones to preserve fertility

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 the talking about fertility page for information.

Some women review their options before treatment and decide to leave their future fertility to chance. Others may try one or more methods to preserve their fertility, especially if one of the methods is more experimental or has lower success rates. Be sure to understand the risks of each fertility option and keep in mind that no method works 100% of the time.

If you didn’t have an opportunity to discuss your options before cancer treatment, you can still consider it later, but there may not be as many choices available.

Embryo development and freezing (cryopreservation)

The process of collecting, developing and freezing eggs or embryos for future use is a standard approach to fertility preservation. The steps described below are generally part of the in vitro fertilisation (IVF) process. This is the most common and successful method of preserving a woman’s fertility.

The IVF process described here starts about 10–14 days after your period. Your specialists will plan to delay cancer treatment or stop it during this time.  

In vitro fertilisation and cancer treatment

Some women with advanced or hormone-sensitive cancer risk their cancer growing during hormone stimulation. In this case, tamoxifen (an anti-oestrogen drug) may be used to prevent cancer growth.

It could also be possible to skip hormone stimulation and collect a few eggs during the woman’s natural ovulation cycle. More research is being done, so talk to a fertility specialist.

Successful pregnancies

At this stage, it’s not possible to give precise figures on the likelihood of pregnancy. However, it’s generally expected that:

  • a hormone-stimulated cycle would result in the collection of 10–12 mature eggs
  • for every 10 eggs frozen, about 3–4 embryos will be created
  • an embryo has a 25–35% chance of developing into a pregnancy.

Over a thousand babies have been born from mature eggs that have been frozen, and millions of babies have been born from frozen embryos.

Storage options

Cryopreserved eggs and embryos may be stored for many years, however some facilities have storage options with a maximum/limited timeframe. If you have frozen embryos, eggs or ovarian tissue, it’s important to ask how long they can be stored, ensure any annual fees are paid and update your contact details. Once you are ready to have a child, the frozen sample is sent to your fertility specialist.  

Ovarian tissue freezing (cryopreservation)

This relatively new process involves taking a piece of your ovary, slicing it and cryopreserving it for future use. It is hoped that when thawed, mature eggs will still develop in the tissue.

  • Removing part of the ovary is a minor surgical procedure – a small cut is made near the belly button to view into the pelvic area (laparoscopy). It can also be done at the time of pelvic or abdominal surgery, if this is part of your cancer treatment.
  • Specialists in the laboratory will fertilise any eggs produced from the ovarian tissue, then the tissue is transplanted (grafted) back into your body.
  • When it’s inside the body, the grafted tissue may grow a new blood supply and produce hormones, but usually some of the tissue dies.
  • Grafts may last a relatively short time (several months to several years), so the graft usually occurs when you are ready to try for a pregnancy.

To date, fewer than 40 births worldwide have been published after this type of ovarian tissue grafting, where the babies have been conceived both spontaneously and using IVF.

"I wanted to do everything that I could and progress as far as I could, even if it wasn’t successful ... At least I’d know that I’d tried everything to make it possible to have a future child. If it didn’t work, I was willing to accept that." – Adelena 

Fertility-sparing surgery

In some situations, it is possible to have surgery to preserve your reproductive organs.

Ovarian transposition (oophoropexy)

The movement of one or both of the ovaries to another area in the body, so that they are out of the field of pelvic radiation. The ovaries are generally moved higher in the abdomen – sometimes as high as the lowest ribs. Ovarian transposition is considered successful if you start menstruating again. This occurs about 50% of the time.

Trachelectomy

The removal of only the cervix, for women with small, localised tumours. A stitch or band is used to close the uterus – there is an opening that allows you to menstruate.

It’s usually possible to become pregnant after a trachelectomy. However, mid-trimester miscarriage and premature delivery are more common. Discuss these risks with your doctor.

Using hormones to preserve fertility

Sometimes hormone treatments are given to try to preserve fertility. This is known as ovarian suppression.

GnRH analog treatment

Gonadotropin-releasing hormones (GnRH) are long-acting hormones used to protect the ovaries and eggs during chemotherapy or pelvic radiation. The hormones reduce oestrogen and cause temporary menopause.  

Hormones are given by injection 7–10 days before cancer treatment starts or no later than one week after treatment starts. The injections continue on a monthly basis until cancer treatment has finished.

GnRH treatment is still being researched to see if it can successfully prolong fertility, particularly in women younger than 35. Your specialist may recommend GnRH as back-up to other fertility options such as egg or embryo cryopreservation.

Progestational agents

Young women with abnormal, precancerous uterine (endometrial) cells may be offered progestational agents (also called progestogens). These hormones may help a woman maintain her fertility. Some successful pregnancies have occurred after this therapy, both spontaneously and with fertility treatments. 

"I now understand what they mean by ‘information means control’. Seeking accurate, reliable information was a huge coping strategy for me. I just wanted to understand what I was in for. I wanted to know everything. My advice is to ask as many questions as it takes for you to understand your choices." – Sonya
Tell your cancer story.

Key points

  • You may have hormone stimulation to develop eggs, which are collected, fertilised (if possible) and frozen. This is generally known as the in vitro fertilisation (IVF) process.
  • Ovarian tissue freezing is a new technique – tissue is taken out then re-implanted into your body so you can try to conceive.
  • Your surgeon may plan an operation to avoid (spare) your reproductive organs.
  • Hormone treatments, known as ovarian suppression, could preserve your fertility.

Reviewed by: Prof Martha Hickey, Head of Obstetrics and Gynaecology, University of Melbourne, VIC; Franca Agresta, Clinical Research Manager, Melbourne IVF, VIC; Alyssa White, National Publications Project Manager, Cancer Council NSW; and Georgia Mills, Cancer Survivor.
Updated: 01 Jun, 2014