Fertility


Women's options before cancer treatment

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

Ask your cancer specialist 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.

Options for preserving fertility in women

Wait and see

What this is

When no method is 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.

Other 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 (see below), check the time limits with the fertility clinic, 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 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.

Other considerations

Your cancer specialists will plan cancer treatment to give you time to have IVF.

Pregnancy rate

Depending on age, the success rate of the fertility clinic, and the stage the embryos are stored at, there may be a 25-40% chance per cycle of an embryo developing into a pregnancy. 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 they may change partners later.

Ovarian tissue freezing (cryopreservation)

What this is

The process of removing, slicing and freezing tiny pieces of tissue from an ovary for later use.

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, the tissue can be removed at this time. 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.

Other considerations

Considered experimental.

There is a risk that storing tissue before treatment begins means it will contain cancer cells. This risk is higher for people with leukaemia. It's important to discuss this risk with your doctor.

Pregnancy rate

To date, approximately 100 births worldwide from ovarian tissue removed after puberty.

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 radiation therapy.

How this works

One or both of the ovaries are moved higher in the abdomen - sometimes as high as the lowest ribs - to lower the amount of radiation your ovaries receive.

Other 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, and if you start menstruating again. It is possible to become pregnant after a trachelectomy.

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 but preserving reproductive organs.

When this is used

For small, localised tumours in the cervix.

How this works

The cervix is partially or completely removed, but the uterus is left in place and is stitched partially closed. This opening is used for menstruation and for sperm to enter.

Other considerations

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

Pregnancy rate

It is possible to become pregnant after a trachelectomy.

GnRH analogue treatment (ovarian suppression)

What this is

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

When this is used

During chemotherapy or pelvic radiation therapy.

Other con

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.

Other considerations

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

Pregnancy rate

Studies suggest this treatment may help women under 35.

How in-vitro fertilisation (IVF) works

Expert content reviewers:

Dr Yasmin Jayasinghe, Paediatric Gynaecologist, Royal Children's Hospital Melbourne, Co-chair Fertility Preservation Taskforce, Melbourne, and Senior Lecturer, Department of Obstetrics and Gynaecology, University of Melbourne, VIC; Dr Peter Downie, Head, Paediatric Haematology-Oncology and Director, Children's Cancer Centre, Monash Children's Hospital, and Director, Victorian Paediatric Integrated Cancer Service, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Aaron Lewis, Consumer; Pampa Ray, Consumer; Dr Sally Reid, Gynaecologist, Fertility SA and Advanced Gynaecological Surgery Centre, Visiting Consultant, Women's and Children's Hospital, and Clinical Senior Lecturer, School of Paediatrics and Reproductive Health, The University of Adelaide, SA; A/Prof Kate Stern, Head, Fertility Preservation Service, The Royal Women's Hospital and Melbourne IVF and Head, Endocrine/Metabolic Clinic, Royal Women's Hospital, and Co-chair, AYA cancer fertility preservation guidance working group, VIC.

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