Oncofertility: Your guide to fertility preservation before cancer treatment
Thanks to improved diagnosis and treatment options, most young people diagnosed with cancer today will go on to survive and thrive. According to LIVESTRONG, the survival rate for all cancer patients under 45 is about 80%. And the survival rate is even better for more common cancers, like breast cancer. According to the American Cancer Society, the average 5-year survival rate for people with breast cancer is 90%. If the cancer is found early enough—when it’s confined to the breast only—the survival rate is 99%; over 60% of breast cancer cases are diagnosed at this early stage.
What does that mean for the priorities of cancer patients? It means they’re able to look past their immediate medical needs and consider their futures, and how their futures might be impacted by the treatment decisions they make now. It means that, as one set of researchers put it, “survivors of cancer do not only want to preserve their lives, but also their quality of life.”
One key area in question? Fertility preservation for cancer patients, a field known as oncofertility. Here, we’ll discuss why cancer patients should consider fertility preservation before treatment, and the options and resources available as you consider this process.
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Many cancer treatments can compromise fertility.
Many necessary cancer treatments may put your fertility at risk. This situation can be remedied by undergoing fertility preservation before life-saving cancer treatment.
According to LIVESTRONG, 30–75% of men and 40–80% of women of reproductive age diagnosed with cancer are at risk of infertility from the cancer treatments that they undergo, “including chemotherapy, radiation, and surgery.”
For people with cancers of the reproductive system, doctors may determine that the best course of treatment is to remove the affected ovary (or ovaries), uterus, Fallopian tubes, testicles, or prostate. Obviously, removal of a crucial part of the reproductive system can make it more difficult or impossible for someone to get pregnant, or impregnate a partner, on their own.
Additionally, even if the whole organ isn’t removed, surgery to remove a tumor or tumors can cause scarring to the reproductive system that can affect ovulation, the ability to carry a pregnancy, or the ability to create sperm or ejaculate.
Patients undergoing these types of procedures who want to have children in the future should consider fertility preservation before surgery.
Chemotherapy works by using medications called cytostatics and cytotoxins to attack fast-dividing cancer cells and kill them or prevent them from dividing. But because the medication is usually administered “systemically,” meaning through the bloodstream to the entire body, it can also attack other cells.
A woman is born with all the eggs she’ll ever have, so during chemotherapy, all of her eggs are at risk of damage from chemotherapy drugs. If the eggs’ DNA is damaged (in other words, if the egg becomes genetically abnormal) it may not fertilize, or may result in miscarriage or birth defects. Learn more about egg quality.
While men’s bodies make sperm consistently throughout their adult lives, chemotherapy can still damage fertility. High doses of chemotherapy can damage sperm cell production and/or affect the testicles’ ability to make testosterone, a crucial fertility hormone.
Men and women about to undergo chemotherapy should consider fertility preservation.
Radiation involves directing high-energy rays at the cancer, in hopes of killing those cells. But by extension, this treatment can also damage parts of the body surrounding the cancer as well, including destroying some or all of a woman’s egg cells or causing scarring in her uterus, Fallopian tubes, cervix, or elsewhere in the reproductive organs, or slowing down or stopping sperm cell production.
The location of the cancer affects whether or not radiation treatment will be absorbed by the ovaries or testicles and damage fertility; those with cancer in the abdominal or pelvic areas are most at risk of infertility from radiation therapy. And because ovulation begins in the pituitary gland in the brain, radiation to that area can affect fertility, as well. While not all women who undergo radiation experience infertility immediately following treatment, the fact that this treatment destroys eggs in the ovaries means a female cancer survivor may go into menopause earlier. Some men who undergo radiation will experience a temporary drop in fertility that recovers in the years following treatment; for others who undergo higher doses of radiation, sperm production may stop permanently.
Depending on the location and dose of radiation, these patients may want to consider fertility preservation if they’d like to have biological children in the future.
Talk to your oncologist to understand if your cancer treatment will affect your fertility, and if you should consider fertility preservation.
Unfortunately, many cancer patients don’t get sufficient information about the risk to their fertility—or their fertility preservation options—before cancer treatment.
A 2016 survey indicated that, of a population of 346 young female cancer survivors with an average age of 30, over 50% “definitely” or “maybe” wanted children, but were unaware of their fertility status post-cancer, and hadn’t taken any steps to preserve their fertility before their treatment. Two thirds of those women were concerned that they would not be able to get pregnant in the future. And sadly, only 13% reported that their doctor spoke with them about options for fertility preservation before their cancer treatment.
Thankfully, there’s been a bigger focus on this conversation in recent years, thanks to studies like this and the work of organizations like FertileAction. But the point remains: if you’ve been diagnosed with cancer and you want to have kids in the future, start this important discussion with your doctor. Ask them if your treatment plan includes procedures that have a chance of putting your fertility at risk, and ask them to refer you to a fertility preservation specialist so you can understand your options.
For women interested in freezing their eggs pre-cancer treatment, our doctors will coordinate care directly with your oncologist. Learn more about egg freezing for women with cancer.
There are several options for fertility preservation before cancer treatment.
Whether you’re a man or a woman, there are several standard and experimental fertility preservation options available for you.
Most common fertility preservation procedures
During egg freezing, the ovaries are stimulated using hormone medication to prompt them to produce multiple eggs in one menstrual cycle, instead of the single egg typically produced. After 8–11 days of closely monitored ovarian stimulation, the eggs are retrieved in an outpatient surgical procedure; while the patient is under sedation, a doctor uses a needle, inserted through the vaginal wall, to collect the eggs directly from the ovaries. The procedure requires no cuts or stitches, and typically, the egg retrieval is the only day off needed during the process.
Learn more about the egg freezing process.
The retrieved eggs are then brought to a lab where they’re immediately vitrified, or flash-frozen. After vitrification, the frozen eggs are preserved in liquid nitrogen at -196ºC, safe from the damaging effects of age or cancer treatments, until the woman decides to thaw them.
Egg freezing is a common type of fertility preservation chosen by single women, and women who want more options when it comes to how, and with whom, they use their eggs down the road.
Learn more about egg freezing before cancer treatment.
Embryo freezing follows much the same process as egg freezing, up until the eggs are retrieved. During embryo freezing, the eggs are taken to the lab and immediately fertilized with sperm from a partner or donor. The fertilized eggs are then allowed to develop for 3–5 days under the careful eye of an embryologist. Finally, the healthy, viable embryos are vitrified and stored at the same -196ºC as eggs, preventing any biological activity.
Many mistakenly believe that embryo freezing is significantly more successful than egg freezing. The truth is that, thanks to vitrification, the difference in success rates between the two procedures is negligible. With embryo freezing, though, you get more information up front: you’ll know right away how many genetically healthy eggs you’re working with, something that can only be understood by attempting to fertilize those eggs.
Learn more about freezing eggs vs. freezing embryos.
Embryo freezing is most often chosen by married or partnered women who know for certain that they’ll want children with a specific known person in the future. We don’t perform embryo freezing here at Extend Fertility, but our partner clinic, Expect Fertility, offers affordable embryo freezing as fertility preservation before cancer treatment or for any other reason.
Learn more about embryo freezing at our partner clinic, Expect Fertility.
Ovarian suppression is a process in which injectable medications are used to cause the ovaries to temporarily shut down before chemotherapy. This is offered to many women undergoing chemotherapy, but the success rates are unknown, so oncofertility experts recommend pairing it with a more conclusively effective option, like egg or embryo freezing.
Fertility preservation for men is, usually, much simpler than it is for women. The most common procedure is sperm freezing; there are no medications required for most men before freezing sperm, and no planning required other than an appointment at a cryobank. There, they leave a semen sample, typically collected via masturbation, to be analyzed, washed, frozen, and stored until needed. It’s often recommended that a man freeze multiple samples, to ensure a good chance of pregnancy later.
Learn more about male fertility decline and sperm freezing.
Less common fertility preservation options
There are several less common or experimental fertility preservation options that are available to those for whom egg freezing, embryo freezing, or sperm freezing is not an option. Those options include:
- Ovarian transposition, a fertility preservation surgery in which the ovaries are moved higher up in the abdomen to prevent them from being affected by radiation. This procedure has good success rates for women undergoing radiation, but doesn’t protect against the effects of chemotherapy.
- Ovarian tissue freezing, a fertility preservation procedure in which a whole or partial ovary, containing immature eggs, is removed and frozen. Later, the ovarian tissue can be re-implanted, or the eggs can be retrieved and matured in a lab. This procedure is experimental, but it does offer a fertility preservation option for prepubescent girls with cancer, who can’t undergo egg freezing.
- Testicular tissue freezing, a procedure in which some of the tissue that produces sperm is surgically removed and frozen. Like ovarian tissue freezing, it’s experimental, but is the only fertility preservation option available for prepubescent boys.
Learn more about female fertility preservation options from LIVESTRONG.
The fertility preservation process does not need to interfere with cancer treatment.
Many women are concerned that pausing to undergo fertility preservation may delay life-saving cancer treatment for too long. The good news is that some fertility preservation options, such as egg and embryo freezing, can be fast-tracked for women who are about to undergo cancer treatment. The entire egg freezing process takes 2–4 weeks, a period which studies conclude does not affect survival chances in most cancer cases.
We offer priority scheduling for cancer patients interested in fertility preservation. Learn more about our egg freezing program for women with cancer.
Many may also be concerned that fertility preservation procedures that require hormone medications, such as egg or embryo freezing, may exacerbate hormone-sensitive cancers, such as breast cancer. However, there are fertility preservation guidelines and protocols available that can prevent these hormones from impacting your cancer. Your fertility preservation specialist will work closely with your oncologist to create a specific protocol that works for your body.
Fertility preservation before cancer treatment gives you multiple family-building options later.
Cancer survivors who undergo fertility preservation before treatment have many options when it comes to family building.
How long you need to wait after your cancer treatment before trying to conceive depends on your type of cancer and the type of treatment you had. Your oncologist is the best source of information about when you can safely get pregnant. The good news is that, after you undergo fertility preservation, there’s no “shelf life” on your frozen eggs, embryos, or sperm—there have been babies born from eggs frozen for 14 years, embryos frozen for 20, and sperm frozen for 30. There’s no evidence that the health of eggs, embryos, or sperm degrades once frozen, so cancer patients who undergo fertility preservation can focus on getting completely healthy before they start their families.
For women who underwent egg or embryo freezing before treatment (who did not have a hysterectomy), they can later thaw their embryos, or thaw and fertilize their eggs with partner or donor sperm. After embryos are thawed or created, one or more will be placed into the uterus in a simple non-surgical procedure known as an embryo transfer: a doctor inserts a catheter through the cervix into the uterus, using an ultrasound for guidance; the microscopic embryo(s) travels through the catheter and is expelled into the uterus, where it hopefully will implant and result in a pregnancy.
For women who had a hysterectomy (removal of the uterus) as part of their cancer treatment, pregnancy won’t be possible. However, they can work with a gestational surrogate or “carrier” to make biological parenthood possible. Fertility preservation before treatment allows the healthiest possible eggs or embryos to be used for IVF before surrogacy.
For women who test positive for one of the BRCA gene mutations, IVF (as used in fertility preservation procedures like egg or embryo freezing) offers an especially important option: genetic testing for their embryos. Known as preimplantation genetic diagnosis (or PGD), this genetic testing is performed on embryos before they’re transferred into the uterus. PGD can ensure that only genetically healthy embryos are transferred, and makes it possible for women who are concerned about passing on their BRCA gene mutations to select only embryos without the mutation for transfer.
Learn more about the BRCA genetic mutations and fertility.
For men who undergo sperm freezing before cancer treatment, the sperm can later be thawed and used to impregnate a partner or surrogate in a procedure known as an intrauterine insemination (or IUI). During an IUI, a doctor places the sperm, which has been thawed and prepared, directly into the female patient’s uterus at the exact point of ovulation. Sperm that’s frozen before cancer treatment can also be thawed and used in IVF.
More experimental forms of fertility preservation, such as ovarian or testicular tissue freezing, require different processes later on. Consult with your fertility preservation specialist for more information.
If you didn’t undergo fertility preservation before cancer treatment, you still have options.
Some women don’t undergo fertility preservation before cancer treatment, perhaps because they weren’t informed about the risks to their fertility or their preservation options (especially common amongst women who had cancer as children), or because their doctor determined that their treatment needed to start immediately.
There is much scientific evidence that demonstrates that even when survivors aren’t immediately infertile due to chemotherapy or radiation, their fertility is dramatically impaired. Because a percentage of their eggs were destroyed by their cancer treatment, they are at risk for infertility or early menopause later in life—a risk that increases as they get older.
Egg freezing is a great option for young women—for example, a mid-20s woman who survived childhood cancer but isn’t ready to have children yet—to preserve some of their remaining eggs and combat their high risk of infertility.
There are fertility preservation financial and support resources available to you.
Fertility preservation procedures can be expensive, and insurance does not always cover them, even in the case of cancer patients. Some states have created legislation that requires insurers to cover fertility preservation before cancer treatment, but there’s no such law in New York just yet.
The good news is that many clinics, organizations, and pharmaceutical companies offer fertility preservation programs for cancer patients that help defray the cost of medical care and medications associated with these procedures, and can offer tailored care or support for those with cancer diagnoses. A few examples:
Extend Fertility Egg Freezing for Women With Cancer
We’ve created a program to make it easier and more affordable for women to preserve their fertility before cancer treatment, including a $700 discount off our egg freezing services and expedited scheduling. We’re a member of the Oncofertility Consortium, an organization of clinics and researchers who focus on fertility care for cancer patients, and our healthcare team has expertise in oncofertility.
Learn more about egg freezing for women with cancer at Extend Fertility.
This organization, founded by cancer survivor Amanda Rice, provides education about fertility preservation options for cancer patients, and works directly with healthcare practices (like ours—we’re a partner) to provide need-based grants to cover the cost of treatment.
Learn more about Chick Mission.
LIVESTRONG Fertility, an arm of the general cancer support organization LIVESTRONG, provides information, support, and financial assistance for men and women affected by cancer who are considering their fertility preservation options. We’re proud to be a LIVESTRONG Fertility partner, meaning that women who pursue fertility preservation here at Extend Fertility are eligible to receive their fertility medications free of charge.
Learn more about LIVESTRONG Fertility.
ReUnite covers up to 100% of fertility preservation medications Follistim, Ganirelix, and Pregnyl, depending on need. Applicants must be female patients with a cancer diagnosis who are about to begin chemotherapy and wish to cryopreserve their eggs beforehand.
Learn more about ReUnite.
Heart Beat Program
The Heart Beat Program covers 100% of select fertility preservation medications purchased through Walgreens Specialty Pharmacy. Eligible patients are female U.S. citizens or permanent residents with a diagnosis of cancer who have not yet initiated chemotherapy and who have not had chemotherapy within the last 6 months; there’s no income threshold. For Extend Fertility patients undergoing fertility preservation before cancer treatment, we’ll complete the application.
Learn more about the Heart Beat Program.
These programs can help cover a large percentage of fertility preservation costs, making it possible for more people with cancer diagnoses who want a family in the future to preserve that option.