Having children may be the very last thing on your mind when you are first diagnosed with a cancer such as leukemia, lymphoma or myeloma. However, many cancer treatment regimes can cause infertility in women. There are options to help retain your fertility, but it is important to consider them as early in your treatment course as possible.
Your options will depend on a number of factors, including your age, the type of cancer you have, the type of treatment you will be receiving, whether or not you have a partner with whom you would consider having children, and the time you have before you start therapy.
Here are some fertility options to consider:Embryo Cryopreservation (Embryo Freezing)
Embryo cryopreservation is the most reliable option for preserving fertility in female patients. During this process, a fertility specialist prescribes medication that will give your ovaries a boost to increase the number of mature egg cells. Then, these egg cells will be retrieved in a surgical procedure.
Once the eggs have been removed, they are fertilized with sperm cells (in vitro fertilization), either from your partner or from a sperm donor. The embryos that are created are then frozen at extremely cold temperatures and stored until you are ready to start a family.
When you are ready to become pregnant, the specialist will carefully thaw one or more embryos and insert them into your uterus, where they can grow into a baby.
Advantages:
- It is a very effective option for those who would like to have their own biological child in the future.
- The embryos can be stored for several years without damage.
- There is no increased risk of health problems for your future baby.
Disadvantages:
- The process may take up to six weeks or more depending on where you are in your menstrual cycle, which may be a long time to hold off on starting treatment
- If you have thrombocytopenia or neutropenia as a result of your disease, the procedure to remove your egg cells may put you at increased risk of bleeding or infection.
- May not be a feasible option for single women or young girls
- May not be covered by health insurance and can be costly
- May not be acceptable to one’s personal, cultural or religious beliefs
Oocyte Cryopreservation
Oocyte cryopreservation (freezing and storing egg cells) is considered an investigational method for women to preserve their fertility. Similar to embryo cryopreservation, a fertility specialist will provide you with medication to stimulate your ovaries to produce egg cells. Then, those egg cells are retrieved in a surgical procedure and frozen for later use.
Advantages:
- You do not need to have a committed male partner at this time.
- There is the option of a process called "in vitro maturation," also experimental, which can retrieve immature egg cells and mature them outside the body. As a result, hormone therapy is not necessary to stimulate the cells, making the process less time consuming.
Disadvantages:
- Because egg cells are large and have high water content, they are difficult to freeze and thaw effectively. There have only been about 120 live births in the entire world from frozen egg cells
- Similar to embryo cryopreservation, thrombocytopenia and neutropenia can play a role in the egg retrieval procedure.
- The process may take two to six weeks depending on your menstrual cycle.
- This is a costly procedure that might not be covered by your insurance plan.
- Your own personal, cultural or religious beliefs about reproductive technology may not find this an acceptable option
Ovarian Tissue Cryopreservation
This option surgically removes your ovary (or a part of an ovary) and freezes it at very low temperatures. When your therapy is complete or you are ready to start a family, the tissue is thawed and re-implanted into your body. In some cases, you may be able to conceive a child naturally after this procedure or you may need to use an in-vitro fertilization technique. This process is also considered experimental.
Advantages:
- May be an option for single women
- Can happen in a timeframe that may not delay treatment
- Does not require hormone stimulation
Disadvantages:
- Any surgical procedure can lead to complications in patients with thrombocytopenia and neutropenia.
- There may be significant out-of-pocket costs not covered by health insurance.
- There is the potential for leukemia or lymphoma cells to be transferred back into the body during the procedure.
Ovarian Transposition
Ovarian transposition (or oophoroplexy) is the surgical moving of the ovaries to another part of the body. This option is used in women who will be receiving radiation to their pelvic area, and its purpose is to try to reduce the exposure of the ovary to radiation damage.
Advantages:
- Does not require the use of any reproductive technologies or drug manipulation to be useful
- Can be done within a short timeframe
Disadvantages:
- Only helpful for women who will not be receiving any therapy other than radiation
- Requires a surgical procedure than can have increased risks in patients with neutropenia or thrombocytopenia
Ovarian Suppression
This is an experimental option for fertility preservation. Researchers have attempted to use oral contraceptive pills and hormones to suppress the activity of the ovaries during cancer treatment. The hope is that fertility damage will be lessened by putting the ovary into a "resting state." There is no evidence at this time to suggest that this method is safe or effective.
Summing Up
Infertility is a potential risk of some cancer treatments. However, there are options for women who are interested in having children in the future. As with many medical procedures, each one of these options has its advantages and disadvantages, risks and benefits.
While you may not know right now if you want to have a baby, it is important that you discuss your options with your doctor before you begin treatment.
Sources
Krebs, L. “Sexual and Reproductive Dysfunction” in Yarbro, C., Frogge, M., Goodman, M., and Groenwald, S. eds. (2000) Cancer Nursing: Principles and Practice 5th ed.Jones and Bartlett: Sudbury MA. (pp.831- 854).
Lee, S., Schover, L. Partridge, A. et al. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. Journal of Clinical Oncology 2006;24(18):2917- 2931.
