Female options before cancer treatment
It’s ideal to discuss fertility options with your specialist before cancer treatment begins. Ask your specialist how long you have to consider your options. In many cases, you can wait a week or two before starting cancer 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 starting treatment, you can still consider your fertility later, but there may not be as many choices available.
Preserving fertility in females
Wait and see
- What this is – when no method is used to preserve fertility.
- When this is used – when you don’t have time to consider fertility preservation or when you choose to start cancer treatment immediately.
- How this works – requires no action.
- Considerations – more likely to lead to premature ovarian insufficiency.
- Pregnancy rate – depends 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. When you are ready to have a child, the frozen egg will be fertilised using IVF or the embryo will be implanted in your uterus.
- How this works – egg and embryo freezing is part of IVF – the most common and successful method for preserving female fertility. One cycle of IVF can take 2–3 weeks. Egg collection is a minor procedure in an operating theatre.
- Considerations – you need time to have IVF before cancer treatment – your cancer specialists will advise how quickly treatment should begin. You don’t need to have a partner to freeze eggs, however to freeze an embryo, you need to have a male partner at both the start and end of treatment, as both partners have to agree to implant the embryo after treatment. Talk with your fertility specialist about whether to freeze eggs, embryos or a mix of both.
- Pregnancy rate – freezing eggs is equally as effective as freezing embryos. For every 10 eggs frozen, you can expect to get 1–4 embryos. 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 a frozen embryo developing into a pregnancy.
Legal limits on how long eggs and embryos can be stored are different in each state and territory – your fertility clinic can advise about time limits and the cost of storage.
Ovarian tissue freezing (cryopreservation)
- What this is – the process of removing, slicing and freezing tiny pieces of tissue from an ovary so it can be used later.
- When this is used – if there isn’t a lot of time before treatment, if taking hormones to encourage egg production is unsafe, if there is a high risk of infertility or if the person hasn’t gone through puberty. Cryopreservation can also be used in addition to egg freezing.
- How this works – tissue is removed from your ovaries during keyhole surgery (laparoscopy). If you have abdominal surgery as part of cancer treatment, tissue can be removed at this time. The tissue is then frozen until needed – when you are ready to conceive, some ovarian tissue is thawed and put back (grafted) into the ovary. The tissue may produce hormones and eggs may develop.
- Considerations – there is a risk that storing tissue before treatment begins means it will contain cancer cells, and you may not want to put this tissue back into your body. This risk is higher for people with leukaemia. It’s important to discuss this risk with your doctor
- Pregnancy rate – around a third of people who have had ovarian tissue put back have become pregnant.
Legal limits on how long ovarian tissue can be stored are different in each state and territory – your fertility clinic can advise about time limits and the cost of storage.
Ovarian transposition (oophoropexy)
- What this is – a type of fertility-sparing surgery that involves surgically 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 ovaries are moved away from the field of radiation and stitched in place. This may lower the amount of radiation your ovaries receive.
- Considerations – may cut off blood supply, causing loss of ovarian function. It is not always successful.
- Pregnancy rate – depends on your age, the amount of radiation that reaches the ovaries and if you start menstruating again.
Trachelectomy
- What this is – a type of fertility-sparing surgery that removes part or all of the cervix, the upper part of the vagina, and lymph nodes in the pelvis. The uterus, fallopian tubes and ovaries are left in place.
- When this is used – for small tumours found only in the cervix.
- How this works – the cervix is partially or completely removed, but the uterus is left in place and stitched partially closed. This opening is used for menstruation and for sperm to enter.
- Considerations – you will be at higher risk of having a miscarriage and having the baby prematurely – you may have a stitch placed in what remains of the cervix to reduce the risk.
- 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.
- How this works – you will have hormone injections 7–10 days before cancer treatment starts or during the first week of treatment. The injections will continue every four weeks until cancer treatment has finished.
- Considerations – may be recommended as a backup to other fertility options or as the only method used to help prevent loss of ovarian function. It can affect bone density so may need menopause hormone therapy if used for more than six months.
- Pregnancy rate – studies show this treatment may help some people.
Female options after cancer treatment
Fertility options after cancer treatment may be limited. Your ability to become pregnant depends on the effects of cancer treatment on fertility, your age and whether you have been affected by premature ovarian insufficiency or early menopause. Options include:
- conceiving naturally
- using eggs or embryos you harvested and stored before treatment, either implanted into your body or a surrogate
- freezing eggs or embryos after treatment ends for later use (if your ovaries are still working)
- using donor eggs or embryos.
Other options such as transplants of the uterus are being studied in clinical trials. Talk to your doctor about the latest research and whether there are any suitable clinical trials for you.
Natural conception
You may be able to conceive naturally after finishing cancer treatment. This will only be possible if your ovaries are still releasing eggs and you have a uterus.
Your medical team will do tests to assess your fertility and check your general health, and will encourage you to try for a baby naturally if they think it may be possible for you to get pregnant. Depending on the treatment you’ve had, they may advise you to wait between six months and two years before trying to conceive.
Even if your periods return after chemotherapy or pelvic radiation therapy, there is a high risk of early menopause. If menopause is permanent, it means you will no longer be able to conceive naturally.
Donor eggs and embryos
If you have early menopause after cancer treatment and have a healthy uterus, you may be able to use donor eggs or embryos to try for a pregnancy. Donors cannot be paid but may receive reimbursement for medical expenses.
It can be difficult to find donor eggs and embryos, and you may have to go on a waiting list. You may be able to use donor eggs or embryos from overseas, however, there are strict rules about importing them into Australia. Talk to your fertility specialist or a lawyer to obtain specific advice for your situation.
Using donor eggs
You will need to find your own donor eggs. Your fertility clinic may have an egg bank or you can ask a family member or friend to donate eggs. All donors are required to have blood tests, answer questions about their genetic and medical information, and have counselling.
After the eggs are collected from the donor, they are combined with sperm from your partner or a donor using IVF. The embryo will be frozen for a few months and then screened for any infectious diseases before it is transferred into your uterus.
Egg donation is more expensive than standard IVF, as you may have to cover hormone-related costs to encourage egg production in the donor.
Using donor embryos
Donor embryos usually come from people who still have frozen embryos after they’ve had successful IVF treatment. Embryos may be donated for ethical reasons (instead of discarding the embryos) or compassionate reasons (to help someone with infertility).
If you use a donated embryo, you will take hormones to prepare your uterus for pregnancy. When your body is ready, the embryo will be thawed and implanted into your uterus using IVF.
Finding information about the donor
In Australia, clinics can only use eggs and embryos from donors who agree that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded. All donor-conceived people are entitled to get identifying information about the donor once they turn 18.
In some states, a central register is used to record details about donors and their donor-conceived offspring. Parents of donor-conceived children, and donor-conceived people who are over the age of 18, can apply for information about the donor through these registers.
In other states and territories, people who want information about their donor can ask the clinic where they had treatment. It is important to discuss possible issues for donor-conceived children with a fertility counsellor.
Fertility and Cancer
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Expert content reviewers:
Dr Ying Li, Gynaecologist and Fertility Specialist, RPA Fertility Unit, Royal Prince Alfred Hospital, NSW; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, NSW, and Lead Clinician for Youth Cancer NSW/ACT; Paul Baden, Consumer; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland; Maurice Edwards, Special Counsel, Watts McCray Lawyers, NSW; Helena Green, Clinical Sexologist and Counsellor, InSync for Life, WA; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, VIC; A/Prof Kate Stern, Gynaecologist and Reproductive Endocrinologist and Head, Fertility Preservation Service, Royal Women’s Hospital Melbourne, The University of Melbourne, VIC; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Renee Van Den Bosch, Consumer.
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The information on this webpage was adapted from Fertility and Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in March 2022.