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 explain treatments that may save (preserve) your fertility and help you get pregnant in the future. Your doctor will talk to you about your options. Some treatments may not be suitable in your situation.

There are different ways of preserving fertility before cancer treatment:

  • Freezing eggs – your ovaries are stimulated to produce more eggs which are collected and frozen.
  • Freezing embryos – the collected eggs are fertilised with sperm. If they develop into embryos, these are frozen.

The NHS often provides embryo and egg storage for women with cancer for at least ten years and for longer in some situations. But in some areas of the UK you may have to pay for it yourself.

A newer way of preserving fertility is to freeze ovarian tissue. This technique isn’t widely available in the UK.

Ways of preserving fertility

It can be difficult to predict if cancer treatment will affect your fertility. Some women may be referred to a fertility clinic for advice before starting cancer treatment. This will depend on their age and type of cancer.

The doctors at the fertility clinic will explain treatments that may save (preserve) your fertility and help you get pregnant in the future. This is called fertility preservation. They will give you information about any risks of fertility treatments. They will also tell you how likely the treatments are to result in pregnancy. This can be a lot of information to take in. You may want to take notes or have some questions ready to ask the doctor. You may be offered counselling or further support to help.

Fertility preservation usually involves stimulating your ovaries with drugs to release more eggs than normal (ovarian stimulation). These eggs are then collected and frozen. This means that the eggs can be fertilised in the future using a partner’s sperm or donor sperm.

Or you may decide to have your eggs fertilised when they are collected. If this is successful, the embryos can be frozen. It is important to know that, if you have a partner who has provided sperm for this, he has equal rights in deciding what happens to the embryos in the future. If he withdraws the right for you to use the embryos, you will not be able to use them.

Even if you have a partner who can provide sperm, you can still choose to have unfertilised eggs frozen. Your partner has no say in how those eggs are used in the future.

Some women may have tissue removed from their ovary and frozen. This may be possible if you have to start cancer treatment quickly or you can’t have fertility drugs. It may also be suitable for girls who haven’t reached puberty.

Ovarian stimulation

Before your eggs are collected, you have injections under the skin of gonadotrophin hormones. This makes your ovaries produce more mature eggs than usual. It is called ovarian stimulation and takes at least two weeks.

Ovarian stimulation is not suitable for everyone. There may not be time for this if you need to start cancer treatment straight away.

For some women there are risks with the drugs used to stimulate the ovaries. These drugs increase the levels of the hormone oestrogen. Doctors are concerned that oestrogen may encourage some cancers to grow. This includes some types of breast, ovarian and endometrial (womb) cancer. Eggs may still be collected:

  • without using drugs to stimulate the ovaries. One or two eggs may be collected in this way. But having fewer eggs reduces the chances of getting pregnant in the future.
  • with one treatment of ovarian stimulation in the usual way.
  • using a hormonal drug called letrozole during ovarian stimulation. Letrozole helps protect you from the effects of oestrogen on cancer cells.

Your doctor will explain any risks of ovarian stimulation and give you information about your options.

Collecting eggs

After ovarian stimulation, you will have blood tests and ultrasound scans. An ultrasound uses sound waves to make an image of your ovaries. This is to check how the follicles which contain the eggs are developing in the ovaries.

When the follicles have developed enough, the doctor uses an ultrasound inside the vagina to guide a needle into the ovaries and collects the mature unfertilised eggs. The ultrasound probe is about the size of a tampon. The collection takes about 15 to 20 minutes. This can be uncomfortable so you will be sedated while it is done. You can usually go home a few hours after. Collecting as many eggs as possible increases your chances of a pregnancy in the future.

How eggs are collected
How eggs are collected

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Freezing eggs

The eggs can be frozen and stored after they have been collected. There are different ways to do this. The most common is to freeze them slowly. However, the most successful way to freeze eggs is a technique called vitrification. This involves freezing the eggs very quickly. This is not available at every fertility clinic. Talk to your fertility doctor about your options.

Freezing embryos

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

As with eggs, embryos can be slowly frozen or quickly frozen by vitrification. Vitrification of embryos results in higher pregnancy rates than slow freezing. But both are safe procedures and many babies have been born using these techniques.

At present, freezing embryos is more likely to result in a pregnancy than freezing eggs. But success rates for freezing eggs are improving.

Storing embryos and eggs

The NHS often provides embryo and egg storage for women with cancer. But in some areas of the UK you may have to pay for it yourself. The staff at the fertility clinic will explain what’s available in your area.

Embryos and eggs can be stored for at least ten years and for longer in some situations. They will be frozen and stored in a tank of liquid nitrogen. This is called cryopreservation.

Freezing tissue from an ovary

Before cancer treatment starts, doctors remove an ovary or small pieces of your ovary by keyhole surgery. These are frozen and stored. These pieces of ovary contain thousands of immature eggs. After cancer treatment, if you decide to try for a baby, the pieces of ovary can be put back into your body. This can make it possible to conceive naturally or with IVF treatment.

This technique is suitable for most women. It is especially suitable for those who have to start cancer treatment quickly, those who can’t have fertility drugs, or girls who haven’t reached puberty. It may not be suitable if there might be cancer cells within the ovary.

This is a newer technique and it isn’t widely available in the UK. Only a few babies in the world have been born using this method.

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Getting support

You may find it helpful to talk to someone about any fertility worries.