Fertility Preservation treatment is an option offered to patients before undergoing chemotherapy or radiation therapy which can affect their ability to conceive. Fertility Preservation for cancer patients is the only treatment presently covered by the Quebec program.
As a result of continued advances in the treatment of cancer, more young adults with cancer are approaching treatment with hope for the future. However some cancer treatments may have serious and lasting effects on the reproductive organs and on fertility. Even when damage to reproductive organs will be permanent, it can be possible to preserve fertility through fertility preservation treatment.
In females, cancer treatment may deplete the reserve of oocytes (eggs) in the ovaries and bring on an early menopause.
Egg/ Embryo Banking
With egg or embryo banking, a procedure can be done to retrieve eggs (oocytes) from the ovaries before cancer treatment begins. These oocytes can then be frozen (or fertilized with partner’s sperm, if desired, and then frozen) by the technique of fast freezing or “vitrification”. Cryopreserved (frozen) eggs and embryos can be stored for many years and thawed for use at the time that pregnancy is desired.
It is always hoped that there will be many eggs (or embryos) for banking because not every egg will give a pregnancy. For this reason most women will follow a course of hormone therapy before egg retrieval. Hormonal therapy is given to stimulate the ovaries to grow a number of eggs instead of the single egg that would normally be produced each month.
Sometimes hormonal therapy is not necessary before egg retrieval. The Reproductive Centre has pioneered a technique of egg maturation, aptly called “in vitro maturation” or IVM, to mature eggs retrieved from the bank of immature eggs stored in the ovary. IVM has been a tremendous innovation that has freed women from the need to take hormone therapy; IVM is especially important to patients with cancer who wish to avoid hormone therapy or who cannot wait for a menstrual cycle and delay the start of cancer treatment.
When pregnancy is eventually desired, the eggs or embryos that were stored will be thawed in preparation for transfer to the uterus (womb). Eggs are fertilized with partner’s sperm and then transferred to the womb for pregnancy.
IVF and IVM are established treatments that have given pregnancies for many years but the Vitrification technique that is used to cryopreserve (freeze) eggs and embryos is newer (although many children have been born both here and elsewhere in the world). Egg and embryo banking to preserve fertility before cancer treatment is also new and therefore it is difficult to be sure of the rate of successes. In general, the chance of pregnancy with IVF and IVM are linked to age of the woman and also to individual level of fertility at the time of treatment.
In vitro treatments are generally found to be safe however there are some risks of treatment that should always be discussed with a health professional.
Other Treatment Options
[collapsed title="Ovarian Tissue Cryopreservation"]
Ovarian Tissue Cryopreservation
Whenever treatment is expected to cause severe permanent damage to the ovaries, surgery to remove all or part of an ovary may be considered. The “rescued” tissue can be frozen (cryopreserved) for many years with the hope that it can later be “transplanted” back or yield eggs when pregnancy is desired. At the time that a pregnancy is desired, additional surgery can be done in a similar way, to return or “transplant” the ovarian tissue to its original place in the hope that it can begin to function naturally.
Ovarian tissue banking (Cryopreservation) and transplant surgery are still considered experimental. So far, there have been just a few attempts to thaw and replace ovarian tissue and these have had mixed results. There have been some reports of temporary return of ovarian function and there have also been a few reports of pregnancy and childbirth, when thawed ovarian tissue has been used. To date, there have been 30 births after transplant of frozen-thawed ovarian tissue. Still, the success rate of this treatment option is not yet known. It is believed that ovarian tissue that contains a large numbers of stored eggs will yield better success with this technique and that success will be higher when more tissue is banked than when less tissue is banked. Perhaps, in the future one can grow eggs from the frozen ovarian tissue.
Laparoscopic surgery is a well established technique. In laparoscopy, the surgeon uses very small instruments (and a tiny camera as a guide) so that only very small incisions are needed. Surgery to remove the ovary or a part of it can be done at any time before radiation treatment is scheduled to start (and can be done after egg or embryo banking.
Ovarian Cryopreservation treatment has some minor as well as some more serious health risks that need to be considered carefully.
[collapsed title="Ovarian Transposition"]
When the plan is for radiotherapy to the pelvis (lower abdomen or belly) area instead of chemotherapy, laparoscopic surgery can be done to move one or both ovaries outside the field of radiation to a “safe” place (high in the abdomen) that will not receive radiation. If this is done, the ovaries will not be affected by therapy and should continue to function normally. However, small amount of radiation might still escape outside the radiation field and might affect the ovaries.
It is not yet known how well the ovary is protected from radiation when it is moved away from the radiation; however about 9 out of 10 women would continue to menstruate through their cancer treatment (and have not had important damage to their ovaries).
Ovarian transposition can be done at any time before radiation treatment is scheduled to start.
[collapsed title="GnRHa Co-treatment"]
Your doctor may suggest you take medication that may make your ovaries less susceptible to damage from chemotherapy by creating a temporary menopause. This “artificial” menopause helps protect the ovaries from potentially toxic chemotherapy medication.