Fertility Preservation Before Cancer Treatment

Infertility in women occurs when the body can no longer produce mature eggs or if there’s an inability to establish or maintain a pregnancy. Women are born with a certain number of eggs in their ovaries and do not produce more throughout life. Cancer treatments can damage or destroy these eggs, causing infertility and premature ovarian failure (also called early menopause).

Options for preserving female fertility before cancer treatments

Egg or Embryo Freezing

These options take 2-6 weeks to complete. If you decide to proceed with egg or embryo freezing after a referral to a fertility specialist, there are several steps in the process:

• Ovarian stimulation- you will receive or give yourself hormone injections each day for ~ 10 days. These hormones will stimulate multiple eggs in your ovaries to mature. During this period of stimulation, you visit the reproductive endocrinologist frequently for blood tests and ultrasounds. These tests show how your ovaries are responding to the hormones, and allow your doctor to adjust dosage if necessary. Once the eggs are fully mature, an egg retrieval is scheduled.
• Egg retrieval- This is an outpatient procedure done with anesthesia. No incision (surgical cut) is needed. Once you are asleep, an ultrasound probe is placed in your vagina so your reproductive endocrinologist can see your ovaries. A very thin needle is passed through the wall of your vagina up to your ovary. Each of the large follicles are punctured with this needle to extract the mature eggs. The procedure takes only 10 to 20 minutes. The eggs are brought to a laboratory to be examined and processed.
• Fertilization- if you are freezing embryos, the mature eggs that were extracted must be fertilized with sperm before they are frozen. At the laboratory, your partner’s or donor sperm is used to fertilize the eggs. This is known as In Vitro fertilization, or IVF.
• Freezing (cryopreservation)- Your unfertilized eggs or embryos are frozen at a laboratory. It is suggested that multiple samples are frozen, since it is possible for specimens to be damaged during the freezing process. However, once frozen, you can keep your unfertilized eggs or embryos frozen for as long as necessary, with no known negative effects.

Ovarian Tissue Freezing

If waiting 2 to six weeks before starting your cancer treatment is not an option, or if you are unable to undergo hormone therapy to mature eggs, ovarian tissue freezing may be an appropriate option. In this procedure, ovarian tissue is surgically removed and frozen. After cancer treatment, the tissue is either surgically implanted back into your body, in the hopes an egg will mature naturally and result in a pregnancy, or eggs are extracted from the tissue and fertilized with IVF.

Ovarian Shielding and Ovarian Transposition

Both techniques are used to shield the reproductive organs from harmful radiation during cancer treatment, and decrease the risk of damage. If you are receiving radiation to the abdomen, ask your radiation oncologist about options for protecting your ovaries. 

Parenthood after cancer

Speak to your oncologist before trying to start a family after cancer treatment, to make sure the damage from treatment has had time to heal. If natural conception or sustained pregnancy is no longer possible due to your cancer treatment, there are other options for having children, including:

• IVF with previously frozen eggs or embryos
• IVF with donor eggs or embryos
• Gestational surrogacy
• Adoption

Any woman who completes cancer treatment but is not ready for children should use a form of birth control. Talk to your doctor about safe options.

Fertility potential decreases when their reproductive organ has been exposed to chemotherapy, radiation or has been altered by surgery due to treatment of the cancer.

Options for preserving male fertility before cancer treatments

Sperm Banking

Sperm banking is the most recommended option for men to preserve fertility before cancer treatment. Sperm samples are frozen and stored for future use, called cryopreservation. Since some sperm can be damaged by the freezing process, it is recommended that men give several sperm samples. Samples can be given daily or every other day, and stored indefinitely. Men who have difficulty providing a sample due to a medical condition or religious or cultural constraints will be provided with alternate options for delivering a sperm sample.

Testicular tissue freezing

If no sperm are present on a semen analysis, a procedure can be done to surgically remove small pieces of testicular tissue, which are then examined for sperm. If sperm is present, the tissue is frozen and used in the future to obtain sperm for fertilization.

Radiation Shielding (or gonadal shielding)

If receiving radiation to the lower abdomen or pelvis, it is important to talk with your radiation oncologist about radiation shielding. Lead-lined shields can be placed over one or both testicles to protect them and reduce the risk of infertility.

Parenthood after cancer

After discussing with your oncologist, it is usually recommended that men wait 18 months to 2 years to naturally conceive to make sure any DNA damaged by treatment has had time to clear the body. If natural reproduction is no longer possible due to your cancer treatment, there are other options for having children, including:

• Assisted reproduction with previously saved sperm (through sperm extraction and IVF with your partner’s egg)
• Donor Sperm
• Adoption

Any man who completes cancer treatment but is not ready for children should use a form of birth control. Talk to your doctor about safe options.