Fertility options and cancer

You might not want to think about your fertility right now – or starting a family – but knowing your options now can make all the difference in your future.

Your doctor or another member of your treatment team should tell you about any risks to your future fertility when they discuss your treatment options with you. If they haven’t yet, tell them you want to know, and think about asking these helpful questions during that discussion: 

• What are the risks of infertility with my treatment plan?

• What can I do to preserve my fertility?

• How much time do I have before I start treatment?

• What happens if I delay treatment to follow through with fertility plans?

• What can I do during treatment to protect my fertility?

• Who do I need to talk to about my fertility options?

• Can you refer me to a fertility clinic?

• How do I know if I will be fertile after treatment?

Fertility preservation

There are a range of options that may be available and right for you.

Your doctor will recommend which ones are appropriate for you and will be suited to your personal needs. The more commonly-used interventions to preserve fertility for people having cancer treatment include: 

• Egg/sperm collecting and freezing

• Radiation shielding

• Specific interventions for ovaries

Egg/sperm collecting and freezing 

The aim of freezing is to collect eggs and sperm that can be frozen (called cryopreservation) which can be used at a later date.

For eggs, the process involves about 10-14 days of hormone stimulation (through hormone injections), then eggs are collected through the vagina under ultrasound guidance.

Undeveloped or immature eggs can be collected and then matured (called in vitro maturation) in the laboratory and then frozen. The process is a bit different from collecting mature eggs because you don’t need to have the same amount of injections prior to the collection of the eggs. Having the hormone injections is what matures the eggs, so without these injections the eggs remain immature. 

Sperm freezing involves making a sperm deposit and then having it frozen. You generally go to a clinic (called an andrology clinic), which could be part of the hospital or a separate IVF or fertility clinic. If you‘re well enough, you can even do your sperm deposit at home.

Your sperm is collected in a jar (this is a completely private part by the way), sometimes up to three different times depending on how well you are and the quality of your sperm, and these are then frozen.

In rare circumstances sperm can be collected from the testes using a needle, usually with a light general anaesthetic.

If you want to develop and freeze an embryo, which is a fertilized egg, the process is very similar with one additional step – the egg and sperm are combined in the laboratory and then frozen. This is a very successful form of treatment but is usually recommended for older people in a serious relationship.

Radiation shielding

If the ovaries or testes are close to where the radiation is directed (but they are not the target for radiation), then they can be shielded from the radiation beams by using protective coverings.

This technique doesn’t guarantee that radiation will not affect your testes or ovaries but it does provide some level of protection. 

Specific interventions for ovaries

There are three techniques for ovaries that can help with fertility preservation.

1. Ovarian tissue freezing: this new and still quite experimental technique involves taking a ‘slice’ of your ovary during a small operation (called a laparoscropy, done under a general anaesthetic). There are many immature eggs in this part of the ovary, which is then frozen. This ‘slice’ is then transported back at a later date in the hopes that your ovary will start to work normally again.

2. Ovary transposition (oophropexy): usually done for people who are having pelvic radiation, this is the surgical movement of one or both ovaries to another area in the body so they’re out of the radiation area. This technique doesn’t protect ovaries against the effect of chemo.

3. Ovarian function suppression using hormone therapies (GnRH analogues): this method protects your ovaries during chemo because it makes them temporarily shut down (also known as temporary menopause).