Preserving your fertility

You may be referred to a fertility clinic for advice before you start cancer treatment. This depends on your age and type of cancer. Doctors will talk about options that may allow you to have a baby in the future.

There are different ways of preserving your fertility:

  • Freezing eggs – your ovaries are stimulated to produce more eggs. These eggs are collected and then frozen.
  • Freezing embryos – the collected eggs can be fertilised with sperm in a sterile dish. The sperm can be from a partner or donor. If the fertilised egg develops into embryos, these are frozen and stored.
  • If you later decide to try to get pregnant, the frozen eggs or embryos can be thawed and put into your womb.

Scientists are researching a technique which involves removing and freezing ovarian tissue that may contain eggs. But very few babies have been born from this technique.

Fertility preservation

Some women, depending on their age and type of cancer, may be referred to a fertility clinic for advice before starting treatment. This is to look at ways that may allow them to have a baby in the future. This is called fertility preservation. At the fertility clinic, you’ll be assessed and given information and counselling about treatments and success rates.

Fertility preservation will involve stimulating your ovaries to produce eggs which are then ‘collected’. It’s not always possible to delay cancer treatment to have this done. Sometimes, depending on the cancer and its stage, your specialist may advise you to start cancer treatment straight away.

If you have a partner who can provide sperm, your eggs can be fertilised and any embryos frozen. If you do this, it is important to remember that your partner has equal rights in deciding what happens to the embryos in future. If he withdraws the right for you to use the embryos, they will have to be destroyed.

If you have any eggs frozen, your partner has no legal rights over their future use.

If you don’t have a male partner, then you can have unfertilised eggs frozen or choose to have them fertilised with a donor’s sperm.

There is a new, experimental technique to preserve fertility. It involves removing and freezing tissue from an ovary.

Sometimes the NHS pays for the freezing and storage of eggs and embryos, but there may be a charge in some areas of the UK. You may also have to pay for donor sperm, and for new and experimental treatments that aren’t available on the NHS.

Some religions don’t agree with any type of fertility treatment. If this is an issue for you, you may want to discuss it with your partner, family or religious adviser. You could also talk in confidence with a trained counsellor or social worker.

Egg collection

You start by having injections of hormones (gonadotrophins) to make your ovaries produce more eggs than usual. This is called ovarian stimulation. Collecting as many eggs as possible, usually at least six, increases your chances of a pregnancy in the future.

The doctor uses an ultrasound probe (sound waves to make an image) to guide a needle into the ovaries to collect eggs. Egg retrieval is performed under sedation to make it less uncomfortable and takes about 15-20 minutes.

Female fertility treatment (labelled)
Female fertility treatment (labelled)

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Ovarian stimulation involves taking the hormone oestrogen. In women with breast cancer, doctors are concerned that ovarian stimulation may encourage breast cancer cells to grow. It may be possible to collect one or two eggs without stimulating the ovaries but this reduces the chances of getting pregnant later on. So women with breast cancer may be offered a single cycle of ovarian stimulation in the usual way.

Another option is to give high doses of a hormonal drug called letrozole (used to treat breast cancer) along with the hormones to stimulate the ovaries. This increases the number of eggs produced while the letrozole gives protection from the high oestrogen levels. Your cancer doctor can talk this over with you.

Freezing embryos

This is the most effective way of preserving fertility. After your eggs have been collected, they’re placed in a sterile dish with sperm from your partner or a donor to encourage fertilisation. This is called in vitro fertilisation (IVF). The eggs that are fertilised grow into embryos, which are frozen and then stored.

In many IVF clinics, embryos are slowly frozen. Some clinics now use a process called vitrification, which freezes the embryo much more quickly. Both slow freezing and vitrification are safe procedures and many babies have been born using these techniques.

When you’re ready to try and get pregnant after treatment, the embryos are thawed and placed in the womb to see if they implant. Usually, no more than one or two are placed in at a time.

Freezing eggs

If you don’t have a partner, you may want to freeze your eggs so they can be fertilised later. This is available privately and on the NHS in some areas.

Eggs are collected as after ovarian stimulation and are frozen and stored. The eggs can be slow frozen but can be damaged by this process. If the eggs can be frozen more quickly by vitrification, they are less likely to be damaged. Talk to your fertility team about your options.

When you’re ready to try to get pregnant, the eggs are thawed and fertilised by injecting a single sperm directly into an egg. This is called intra-cytoplasmic sperm injection (ICSI). This procedure is done in a laboratory. A tiny pipette (dropper) holds the egg. A fine needle is used to inject a single sperm directly into the egg. If an egg is successfully fertilised, the embryo will be placed in your womb to see if a pregnancy develops.

ICSI injection labelled
ICSI injection labelled

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Freezing eggs and ICSI are less likely to result in a pregnancy than embryo storage, but success rates are improving.

Freezing tissue from an ovary

Before cancer treatment starts , small pieces of tissue containing eggs, are taken from an ovary and are frozen and stored. After treatment, the tissue can be put back into the body to allow eggs to develop.

This may be suitable for women who don’t have time to freeze embryos or eggs. It may also be suitable for women who can’t use fertility drugs and girls who haven’t reached puberty.

This technique is still very experimental. There have been only a few babies in the world using this method, and none to date in the UK.

Back to Fertility in women

Getting support

Many women find it helpful to talk to family, friends, counsellors or other women in similar situations when coping with infertility.