Fertility Preservation for Women Diagnosed with Cancer
Starting the Conversation
Fertility Preservation for Women Diagnosed with Cancer
Introduction
Many women of childbearing age who have been diagnosed with cancer think that preserving their fertility is important and want information about their options. However,
- Patients may not feel comfortable bringing up fertility issues.
- Patients may not be aware of their options for preserving fertility.
- Patients may be focused on their cancer diagnosis and unable to think about fertility or the possibility of having a future family.
Women may later regret not considering fertility issues prior to starting cancer treatment.
Understanding that there are fertility preservation options available and referring at-risk patients to specialists can improve patients’ emotional outlook and future quality of life.
Even women with a poor prognosis may want to consider fertility preservation.
Fertility Preservation - Where Does It Fit?
a) See table below
b) See figure below
Starting the Conversation
You may not be comfortable speaking with your patients about the risk of infertility related to their cancer or planned cancer treatment. These key points can help start the conversation:
- Cancer and cancer treatment may affect your fertility.
- Based on your treatment plan, your risk of infertility is [high, moderate, low].
- Have you ever thought about having a child/more children? Although it may not be on your mind now, many patients find themselves wishing they had thought about this when they had the chance.
- You have options to try to preserve your fertility before you begin cancer treatment.
- Cancer, cancer treatment, or fertility preservation will not harm your future children. (Although you may pass on the gene for some hereditary cancers, we may be able to test for those).
- You may retain or regain your fertility, or not make use of any fertility preservation methods you may have used. However, it is important to explore your options now to avoid regret in the future.
- Fertility preservation and pregnancy do not appear to increase the risk of cancer recurrence; however, pregnancy may be considered high risk.
- I can refer you to a fertility preservation specialist if you would like to discuss your options further.
- Remember that there are other ways to build a family after cancer if we are unable to preserve your fertility now. Talking with a specialist can help you explore other options that might be right for you.
Options for Fertility Preservation
The following table gives a brief description of options available to women who wish to preserve their fertility.
The American Society of Clinical Oncology and American Society for Reproductive Medicine recommend that, when possible, at-risk patients be referred to a fertility preservation specialist prior to starting cancer treatment.
Several resources are listed on the back cover that can help you and your patients locate a fertility preservation specialist.
Fertility preservation options for women diagnosed with cancer
| Option | Definition | Timing | Time Requirement | Other Considerations |
| Embryo Banking | Harvesting eggs, IVF, and freezing of embryos for later implantation | Before or after treatment | 10–14 days from menses; outpatient surgical procedure | Need partner or donor sperm |
| Egg Banking (Experimental) | Harvesting and freezing of unfertilized eggs for IVF and implantation after cancer treatment | Before or after treatment | 10–14 days from menses; outpatient surgical procedure | May be attractive to single women or those opposed to embryo creation |
| Ovarian Tissue Banking (Experimental) | Freezing of ovarian tissue and reimplantation of tissue or in vitro maturation of follicles and fertilization of eggs after cancer treatment | Before or after treatment | Outpatient surgical procedure | Tissue not suitable for transplant if high risk of ovarian metastases; no live births to date from in vitro maturation |
| Radiation Shielding | Use of shielding to reduce scatter radiation to the ovaries | During treatment | In conjunction with radiation treatments | Does not protect against effects of chemotherapy |
| Ovarian Transposition | Surgical repositioning of ovaries away from the radiation field | Before treatment | Outpatient procedure or in conjunction with gynecologic cancer surgery | |
| Radical Trachelectomy | Surgical removal of the cervix with preservation of the uterus | During treatment | Inpatient surgical procedure | Limited to early stage cervical cancer |
| Ovarian Suppression (Experimental) | GnRH analogs or antagonists used to suppress ovaries | During treatment | In conjunction with chemotherapy | Does not protect from radiation effects |
| Donor Embryos | Embryos donated by a couple | After treatment | Varies; is done in conjunction with IVF | Donor embryo available through IVF clinics or private agencies |
| Donor Eggs | Eggs donated by a woman | After treatment | Varies; is done in conjunction with IVF | Patient can choose donor based on various characteristics |
| Gestational Surrogacy | Woman carries a pregnancy for another woman or couple | After treatment | Varies; time is required to find surrogate and implant embryos | Legal status varies by state |
| Adoption | Process that creates a legal parent–child relationship | After treatment | Varies depending on type of adoption | After puberty; medical history may be a factor |
Table adapted from 2006 American Society of Clinical Oncology recommendations on fertility preservation in cancer patients; and Fertile Hope. Cancer and Fertility: Fast Facts for Reproductive Professionals.
IVF=in vitro fertilization • GnRH=gonadotropin-releasing hormone
Cancer Therapy and the Risk of Infertility
For women of childbearing age, the first step to fertility preservation is assessing the risk of developing infertility secondary to their planned cancer treatment.
The following table classifies various cancer therapies and regimens based on their known infertility risk in women (defined as permanent amenorrhea).
Fertile Hope also provides an online risk calculator.
For patients who wish to try for a pregnancy, it is important to take into account the patient’s age when planning their cancer treatment. Patients who are over the age of 35 may have reduced fertility preservation options.
Infertility risk associated with specific cancer treatments and regimens
| High Risk |
|
| Intermediate Risk |
|
| Low Risk |
|
| No Risk |
|
| Unknown Risk |
|
Table adapted from the 2006 American Society of Clinical Oncology recommendations on fertility preservation in cancer patients; Fertile Hope. Cancer and Fertility: Fast Facts for Reproductive Professionals; and Meirow D, et al. Clin Obstet Gynecol. 2010;53:727-739.
CMF=cyclophosphamide/methotrexate/fluorouracil • CEF=cyclophosphamide/epirubicin/fluorouracill • CAF=cyclophosphamide/adriamycin (doxorubicin)/fluorouracill • MOPP=mechlorethamine/oncovin (vincristine)/procarbazine/prednisonel • MVPP=mechlorethamine/vinblastine/procarbazine/prednisolonel • COPP=cyclophosphamide/oncovin/procarbazine/prednisonel • ChlVPP=chlorambucil/vinblastine/procarbazine/prednisolonel • EVA=etoposide/vinblastine/adriamycinl • BEACOPP=bleomycin/etoposide/adriamycin/cyclophosphamide/oncovin/procarbazine/prednisonel • ABVD=adriamycin/bleomycin/vinblastine/dacarbazinel • AC=adriamycin/cyclophosphamidel • CHOP= cyclophosphamide/hydroxydaunomycin/oncovin/prednisonel • COP=cyclophosphamide/oncovin/prednisonel • MF=methotrexate/5-fluorouracil
Resources
For more information about infertility risk, fertility preservation options for women diagnosed with cancer, and how to locate and refer your patients to a fertility preservation specialist:
- Visit SaveMyFertility, a joint resource of the Oncofertility Consortium® and The Hormone Foundation®
- Call the FERTLINE: 866-708-FERT (3378), or visit the Oncofertility Consortium® Web site
- Visit the Fertile Hope Web site
- Visit the American Society for Reproductive Medicine Web site
- Visit The Hormone Foundation® Web site
References
- Ethics Committee of the American Society for Reproductive Medicine. Fertility preservation and reproduction in cancer patients. Fertil Steril. 2005;83:1622-1628.
- Fertile Hope. Cancer and Fertility: Fast Facts for Reproductive Professionals. 2008. www.fertilehope.org/uploads/pdf/FH_RP_FastFacts_08.pdf. Accessed February 11, 2011.
- Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009;360:902-911.
- Lee SJ, Schover LR, Partridge AH, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:2917-2931.
- Meirow D, Biederman H, Anderson RA, Wallace WH. Toxicity of chemotherapy and radiation on female reproduction. Clin Obstet Gynecol. 2010;53:727-739.
- Thewes B, Meiser B, Taylor A, et al. Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol. 2005;23:5155-5165.
- Tschudin S, Bitzer J. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update. 2009;15:587-597.
- Woodruff TK. The Oncofertility Consortium—addressing fertility in young people with cancer. Nat Rev Clin Oncol. 2010;7:466-475.
The Oncofertility Consortium® is a national, interdisciplinary initiative designed to explore the reproductive future of cancer survivors.
The Hormone Foundation®, the public education affiliate of The Endocrine Society®, serves as a resource for the public by promoting the prevention, treatment, and cure of hormone-related conditions through outreach and education.
The development of this pocket guide was supported by educational grants from Merck and EMD Serono.
© 2011 The Oncofertility Consortium® and The Hormone Foundation®
