EXPLAINED

Cancer and Fertility Preservation

FERTILITY PRESERVATION

Cancer and Fertility Preservation

Understanding your options before treatment

Cancer diagnosis and fertility preservation

Being diagnosed with cancer is undoubtedly a frightening experience. The shock, fear and worry can send you spiralling and if you’re going through this right now, then our hearts go out to you and we wish you all the best.

Amongst the treatment options available to you, you may also be considering your future fertility – if you want to start or expand your family, depending on your personal circumstances, you may have options available to you that could mean that you can preserve your fertility in order to increase your chances of having a biological family in the future.

Fertility preservation involves the freezing of either eggs or sperm, embryos or reproductive tissue such as ovarian or testicular tissue. You may want to consider this if your particular cancer affects the organs required for fertility or if your treatment, such as radiotherapy, will interfere with your fertility.

Your doctors may be focussed on your cancer care, so you may have to start the conversation around your fertility. But either way, your medical team will be on hand to discuss your options before your cancer treatment begins. Your age, overall health, personal circumstances and treatment outcome will ultimately influence any future successful pregnancies and your medical team will advise how to maximise your chances.

Egg and embryo freezing

Egg, or oocyte, freezing involves a process similar to the start of IVF in order to encourage your ovaries to release more than one egg, so that multiple eggs can be collected and then any viable eggs frozen.

After your cancer treatment, or at a later date, depending on your doctor assessment, you may then be able to use these eggs and your partners sperm or donor sperm to fertilise them and then implant them into your womb if you’ve been unable to become pregnant.

Embryo freezing is very similar in that you’ll undergo IVF style procedures in order to collect multiple eggs. Any viable eggs are then fertilised using either your partners sperm or donor sperm, and the embryos frozen, rather than being implanted back into your womb as they would be during IVF. They can then be implanted after your cancer treatment or at a later date if you’re fit and well.

As a general rule, both processes begin by using daily self-administered injectable hormones that influence your ovaries. The day that you start and how long the process takes will depend on your menstrual cycle and whether you’re opting for egg or embryo preservation. These hormones can cause unpleasant side effects similar to that of intense period related symptoms such as pain and mood swings.

After a few days or weeks of ovarian stimulation and multiple scans to check the progress of your ovaries, you may then be ready for egg collection. Egg collection for both egg and embryo freezing involves passing a long, thin catheter into your vagina and through the vaginal wall to the ovaries in order to harvest the available eggs. This can be uncomfortable but you’ll be sedated throughout.

If you’re freezing your eggs, viable eggs will then be frozen at the clinic. If you’re freezing embryos, viable eggs will be fertilised and monitored for several days. Any viable embryos will then be frozen.

Ovarian tissue preservation

Whilst this is still a relatively new procedure, some women and young girls are eligible for ovarian tissue preservation. The procedure can be carried out before or after puberty.

You will undergo a keyhole surgical procedure called a laparoscopy that involves your surgeon passing long, thin surgical instruments into your pelvic area via surgical cuts in your abdomen whilst you’re under a general anaesthetic.

Your surgeon will remove thin strips of tissue from your ovaries which will then be frozen. At a later date following your cancer treatment, this tissue can then be thawed and transplanted back onto your ovaries.

It may then begin to function again, releasing eggs that may then become fertilised naturally or via IVF techniques.

Ovarian suppression

Ovarian suppression is a procedure that uses hormonal drugs to temporarily shut down the activity of the ovaries by putting a woman into a temporary menopause. The theory is that whilst they’re shut down, the ovaries are protected from the potentially damaging effects of certain cancer treatments. It will however cause menopause symptoms that can be unpleasant.

It’s in its infancy but doctors hope that once the treatment has ended and the ovaries begin to function again, they may be less likely to have sustained damage.

Infertility after cancer treatment

In some cases, such as if a woman has had to have her ovaries or womb removed due to cancer or despite fertility preservation techniques, a woman may be infertile.

Depending on the circumstances, there may be other options available such as using a donor egg or donor embryo fertilised either with your partners sperm or donor sperm which can then be implanted if you have a womb.

Gain, depending on your circumstances, you may need to undergo some hormonal treatments such as daily self-administered injections in order to prepare your womb and support a growing embryo.

If you no longer have a womb, or you’re unable to carry a pregnancy full term, you may be able to consider surrogacy. A surrogate can receive an embryo created using your egg or a donor egg, fertilised with your partners sperm or donor sperm. In this case, the surrogate has no genetic relationship to your baby.

Alternatively, a surrogate can undergo IVF style procedures to harvest a mature egg that can then be artificially inseminated using your partners sperm or donor sperm. The embryo is then implanted back into her womb, and she will be genetically related to your baby.

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