Options before cancer treatment

Cancer treatments pose a risk to your fertility, but there are things that you can do that may help to preserve your fertility before your treatment begins.

They include:

• freezing eggs, ovarian tissue or embryos for later use
• protecting the ovaries during chemotherapy or radiotherapy.

Your choices will depend on your individual circumstances such as:

• your desire for children in the future
• your current relationship situation
• your tumour type and hormone-sensitivity
• the particular treatment type planned
• the time available before cancer therapy is to start.

Freezing ovarian tissue

This process begins with a procedure called a laparoscopy, performed under general anaesthetic. You will usually need to stay in hospital for one day with this procedure. During the procedure a small piece of ovarian tissue is removed from one ovary and then cut into tiny slices and frozen.

Later, when you are ready to conceive, the ovarian tissue slices are grafted back into your pelvis. Around four to five months later, the grafted ovarian tissue can start to produce reproductive hormones and develop follicles.

Pregnancy may be achieved either with ovarian stimulation and IVF, or it may occur with no medical help at all!

There are many studies that show babies are successfully conceived and born using this technology.

Freezing embryos

This procedure begins with injections to stimulate the hormones that produce follicles and bring eggs to maturity. This happens over 10 to 14 days. Mature eggs are then removed from the ovaries (using ultrasound-guided aspiration, through the vagina). This is done under sedation. The retrieval process takes about 10 minutes. The eggs are then fertilised outside your body, using your partner’s sperm. Once fertilised the embryos are frozen so that they can be used later. Embryos tend to survive the freezing/thawing process better than mature eggs. We expect about 80 to 90 per cent of embryos to survive once frozen and thawed. Depending on your age the chance of successful implantation with each embryo is between 25 and 45 per cent.

Freezing mature eggs

This option is for single women. The procedure begins with 10 to 14 days of hormone stimulation. Mature eggs are then removed from the ovaries (using ultrasound-guided aspiration, through the vagina). This is done under sedation. The retrieval process takes about 10 minutes. The mature eggs are then frozen.

Ultrasound-guided aspiration

With recent scientific advances we expect 80 to 90 per cent of the eggs to survive the freezing/thawing process for potential fertilisation using IVF. About 50 to 70 per cent of eggs fertilise normally. This means that for every 10 eggs frozen, we can expect about three to four good quality, usable embryos to be created successfully.

You may have enough time before starting your chemotherapy and radiotherapy treatment to have more than one cycle of hormone stimulation and egg retrieval. This ensures that you have a reasonable number of eggs to freeze and therefore an increased chance of a future pregnancy.

For women with hormone-sensitive tumours such as receptor-positive breast cancer, there is a possibility that the hormones used for ovarian stimulation could have a stimulating effect on breast cancer cells. It is impossible to be absolutely sure that the ovarian stimulation is completely safe for women with hormone-sensitive breast cancer.

There have been several reports of the use of the drug Tamoxifen for ovarian stimulation; however, there are no large studies confirming its benefit in this situation. Tamoxifen is a drug that is used in the treatment of breast cancer to block the effects of oestrogen on the breast.

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