Medical Fertility Preservation for Women
If you need to have cancer treatment while you are younger, you may be wondering if you’ll still be able to have children in the future. Many treatments for cancer carry particular risks to your future fertility. The impact can be temporary or permanent, and in some cases could result in infertility.
This could be caused by:
- The ovaries being unable to produce mature eggs (ovarian failure),
- Disruption in hormonal signaling between the brain and the ovaries,
- Damage to the uterus or fallopian tube from surgery to the abdomen or pelvis, or radiotherapy,
- Chemotherapy causing temporary or permanent damage to eggs and follicles.
If you are about to undergo cancer treatment, there are several options that your fertility specialist will discuss with you, including freezing embryos, ovarian tissue, and mature eggs. There are also some medications that can protect your ovaries from damage during chemotherapy. The type of cancer you have, your treatment plan, your age and circumstances will all need to be considered.
Freezing embryos
If you have a partner, depending on the circumstances of your relationship, you can choose to undergo IVF treatment prior to commencing chemotherapy or radiotherapy, and any resulting embryos can be frozen for future pregnancy attempts, often years later.
An IVF cycle involves 10-14 days of hormone stimulation prior to the woman’s mature eggs being collected in a day surgery and fertilised with her partner’s sperm in the laboratory.
Depending on the type of cancer diagnosis and the urgency of your oncology treatment, this is the preferred option, as embryos tolerate freezing considerably better than ovarian tissue or egg freezing, and the subsequent embryo survival and chance of a pregnancy is much higher. The pregnancy success rate depends usually on the age of your eggs at the time of treatment.
Ovarian tissue freezing
There are now several studies suggesting ovarian tissue freezing could be a useful treatment option as a few babies have now been born after using this technology.
It involves removing a small piece of ovarian tissue from one ovary, cutting it into tiny slices and then freezing. Later, when you are ready to conceive, the ovarian tissue slices are grafted back into your pelvis. Around nine months later, the grafted ovarian tissue can start to produce reproductive hormones and follicular development.
Pregnancy may be achieved either with ovarian stimulation and IVF, or perhaps even naturally.
Further research and experimental work needs to be completed before this will be routine clinical treatment; at present we still consider this to be experimental.
Freezing eggs
While embryo and sperm freezing are well-recognised infertility treatments, with many thousands of babies born as result, egg freezing is a relatively new option for women who want to preserve their fertility – either for medical or social reasons.
For women who undergo this procedure, eggs are collected during an IVF cycle and are frozen, sometimes for many years. When the woman is ready to use her eggs, they are thawed, and then fertilised with sperm. A healthy fertilised egg will develop into an embryo, which may then be transferred to the woman’s uterus, with a subsequent chance of pregnancy.
Depending on your circumstances, you may have enough time before starting your chemotherapy or radiotherapy 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.
Fertility preservation for social reasons
Age-related infertility in women is one of the most common issues presented to fertility specialists each day when trying to help patients become pregnant.
At Melbourne IVF, we encourage all initiatives that can educate women and improve social support so that women can optimise their chances of having a family before the natural decline of ovarian function. However, we recognise that for some women child-bearing will have been unavoidably delayed.
A woman’s most fertile years are in her 20s and early 30s, when the ovaries still contain a large number of healthy eggs. For the 10 to 15 years before menopause, despite a woman having regular monthly periods, the ovarian function declines. This is especially so for women in their 40s.
So if you want to have a child in the future, but have not had the opportunity during your most fertile years, then freezing your eggs for use in the future - when you have met the right partner, or are ready to start your family - may be an option for you.
Success rates for egg freezing
As the technique for egg freezing is relatively new, it is not possible to give precise figures for the chance of pregnancy after freezing.
Currently we would expect that:
- a stimulated cycle would result in the collection of 10-12 eggs
- approximately 60-70% of eggs would survive thawing
- approximately 50-80% of surviving eggs would fertilise
- approximately 90% of fertilised eggs would develop into embryos
- a single embryo would have a 15-35% chance of developing into a pregnancy.
Other factors, especially the woman’s age when her eggs are frozen, have an important effect on the chance of pregnancy: the younger the woman, the better the chance. Egg freezing in women over the age of 37-38 would be expected to have a lower chance of pregnancy.
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