When presented with a cancer diagnosis, many young women are concerned with how it might affect their fertility and whether or not starting or adding to a family is still a possibility. But, thanks to a variety of different fertility preservation options, doctors are making it possible for women to beat cancer and be a parent.
“Fertility preservation should be a consideration before, during, and after cancer treatment for any woman of child-bearing age,” says Xiaomang Stickles, MD, FACOG, a gynecologic oncologist at Lankenau Medical Center, part of Main Line Health. “As women leave their twenties behind and choose to begin families later, they are at an increased risk of receiving a cancer diagnosis before their family is complete. But many times, women don’t need to choose between cancer treatment and having a family.”
Although being faced with a cancer diagnosis and the decision of having to delay having a family can be an emotional and frightening one, the good news is that there are many options available.
“The treatment of gynecological cancers has shifted over the past decade from a one-size-fits-all approach to being more tailored to the patient and her family planning goals,” says Dr. Stickles.
Below, Dr. Stickles explores some of the most common fertility preservation options.
Embryo / egg freezing
When most women think of fertility preservation, they likely think of freezing embryos or eggs to be used for a later pregnancy. While some may use the terms interchangeably, there are some key differences between both procedures.
Embryo freezing has been one of the most successful methods of fertility preservation for decades. Medications are administered to stimulate the ovaries, and eggs are removed prior to chemotherapy or a surgery that would negatively impact a woman’s future fertility. These eggs are then fertilized with sperm, and embryos are formed, which can be frozen for many years. Following successful cancer treatment, the embryo(s) can be thawed and implanted to achieve pregnancy.
“Embryo freezing is the best option for women who are married or have a designated heterosexual partner, but it’s also an option for single women who wish to use a sperm donor,” says Dr. Stickles. “Another option is egg freezing.”
Egg freezing is similar to embryo freezing. The process of stimulating ovaries is the same as it is for embryo freezing; however, the eggs are frozen without being fertilized. The pregnancy rates using frozen eggs have dramatically improved over the past 10 years to a point where it is almost as effective as frozen embryos. Egg freezing is no longer considered an experimental procedure.
This is a more popular option among younger women who may not have a reproductive partner yet. Following successful cancer treatment, the egg(s) can be thawed, fertilized with sperm–either from designated partner or donor–then implanted to achieve pregnancy.
Ovarian transposition and ovarian shielding
Protecting the pelvic reproductive organs from radiation can go far in preserving fertility. Two preservation methods, in particular, use this method of protection—ovarian transposition and ovarian shielding.
Ovarian transposition is an outpatient procedure that is performed prior to a woman beginning radiation therapy, and requires moving the ovaries away from a targeted area of treatment. Following treatment, many women will retain ovarian function.
Ovarian shielding is a procedure performed during radiation therapy. The technique uses lead shields to guard a woman’s pelvic area during courses of radiation. Newer radiation techniques such as intensity-modulated radiation therapy (IMRT), available at Main Line Health, can also dramatically reduce the collateral damage to the ovaries during radiation treatment.
The goal of ovarian suppression treatment is to temporarily shut down the ovaries and protect them from the damages that can occur as a result of cancer treatment. Inactive ovaries are less susceptible to the damaging effects of chemotherapy.
Medications to induce temporary menopause are given as injections every month or every three months. Although the medication is safe, prolonged use beyond 18 months has been associated with weaken bones. Therefore, this method is not generally recommended for those who expect to receive chemotherapy for long periods of time.
Surrogacy can be an option for women who are not able to carry a pregnancy because of an increased risk of cancer recurrence, or for women who have undergone a hysterectomy as part of her cancer treatment. There are two different types of surrogacy for women to consider:
- A gestational surrogate, or gestational carrier: a healthy woman who is impregnated using the egg and sperm of the intended parents of the child. In this case, the carrier does not give a genetic contribution to the child. While not specifically outlawed in most states, some states’ laws are more friendly than others. Check with your state regarding surrogacy laws.
- A traditional surrogate: a woman who is impregnated via artificial insemination using the sperm of the intended father of the child. In this case, the surrogate does give a genetic contribution to the child. This is illegal in some states.
Choosing a surrogate is an emotional and lengthy process, but one that can be very rewarding. Familiarize yourself with the surrogacy laws in your state, and work with your partner to determine what type of surrogacy is important for you, and which individual will be the right partner for you in this journey.
Domestic and international adoption remains another option for parents. Some agencies have strict criteria in selecting adoptive parent candidates, and Dr. Stickles cautions patients that a history of cancer may make the process more complex, and some agencies require documentation of cancer-free status and prognosis and/or life expectancy. If you are interested in adoption, a social worker at an adoption agency can help you better understand your candidacy.
Finding the right choice for you
As cancer treatments have advanced and offer more women the chance of a long and fulfilling life, fertility and quality of life should part of the conversation during the course of cancer treatment. A woman of reproductive age facing a cancer diagnosis should consider consultation with a reproductive endocrinologist (REI) in parallel with an oncologist.
Although there are many options for fertility preservation, Dr. Stickles reminds her patients of one thing:
“Each patient should discuss her goals and her situation with her oncologist, but she should be encouraged to discuss these goals from her very first appointment and throughout her treatment.”
It’s important to know the potential risks to you and your baby during pregnancy–and to address any medical issues you may have before you get pregnant. If you’re facing cancer, heart disease, or other risk factors, Main Line Health offers maternal-fetal medicine and fertility specialists who can help guide you to a healthy pregnancy.