What Are the Options for Preserving Fertility After Ovarian Cancer?
An ovarian cancer diagnosis is devastating. But if the diagnosis comes during family planning or even while thinking about having kids, it can bring up concerns about future fertility. Although being diagnosed with ovarian cancer and receiving treatment can affect the ability to become pregnant, there are several options available to help preserve fertility.
There is no single or right approach to preserving fertility. This is because each individual’s case is unique and depends on several factors, including the type and stage of cancer, specific type of cancer treatment (radiation, surgery, and/or chemotherapy), the time available for fertility preservation before starting treatment, physical and sexual maturity, as well as personal preferences. If you have been diagnosed with ovarian cancer, it is recommended to discuss your personal risk of infertility and fertility preservation options with your doctor before starting your cancer treatment. You should always choose what you feel is right for you.
Cancer and fertility
The harmful effects of cancer treatment on your fertility depend on the stage of the cancer, treatment, as well as the age at which you are receiving treatment. Surgical removal of the ovaries, fallopian tubes, and uterus can compromise fertility and high doses of chemotherapy and radiation therapy can affect the functioning of the eggs, hormones, and ovaries. In turn, damage to these organs can decrease your ovarian reserve, which is the total count of immature eggs in both of your ovaries. If ovarian cancer is diagnosed at an early stage and has affected only one of your ovaries, it may be possible to preserve the uterus and the ovary that is left unaffected may stay fertile. However, there is the possibility that chemotherapy drugs, known as alkylating agents, may cause damage to the ovary left unaffected or increase your risk of developing premature menopause.
If you are not able to get pregnant through natural means, there are other options available. Consider speaking with your doctor, gynecologist or a reproductive endocrinologist – a doctor who specializes in the branch of medicine relating to reproduction, menopause and infertility. Have him or her answer a few questions for you, including:
- What are my options for preserving my fertility?
- Does my age affect my options?
- Can fertility drugs or other fertility preservation approaches cause my cancer to return?
- How can I learn more about the costs for each option available to me?
- Are there any ethical or legal issues I should know about that relate to my fertility options?
A reproductive endocrinologist can help to plan the most appropriate treatment for you, all while addressing the impact of cancer on your life and your chances of becoming a mother post-treatment. “There’s actually a lot more options available for women now than there was in the past,” said Dr. Iris Romero, Obstetrician-gynecologist. “I think the most critical step a woman can take is to have a long-standing and trusting relationship with her gynecologist,” she added.
Fertility options
In vitro fertilization
In vitro fertilization (IVF) is a process in which your eggs are fertilized by sperm (either from your life partner or a donor) and then placed back your the womb. Depending on the time of your diagnosis, it may have been possible to harvest your eggs before starting your cancer treatment. If, however, it is not possible to harvest your eggs before starting your cancer treatment, you can still use an egg from a donor.
Egg freezing
Egg freezing, also known as oocyte cryopreservation, is a process that involves having your unfertilized eggs harvested and frozen to be used in the long run.
Radical trachelectomy
Radical trachelectomy involves the surgical removal of your uterine cervix. The procedure can help to preserve your uterus.
Ovarian suppression
Ovarian suppression is an approach to fertility preservation that is still being researched. It involves taking hormones that prohibit proper functioning of your ovaries as a means to protect your eggs from cancer treatment.
Ovarian tissue preservation
Ovarian tissue preservation is an approach that involves surgically removing and freezing ovarian tissue to be used in a transplant after cancer treatment.
If you have undergone a total hysterectomy and IVF is not a possibility for you, there are other options that you can consider:
- Surrogacy – A method in which another woman (the surrogate) is naturally or artificially inseminated with sperm from your life partner or a donor and carries a pregnancy for you full-term. There are two common types of surrogacy – traditional and host surrogacy.
- Adoption – Even though a majority of adoption agencies do not dismiss cancer survivors as potential parents, they often require a letter from your doctor stating that you have been cancer-free (preferably for 5 years) and that you can expect to live a healthy life.
- Foster care adoption – A type of adoption in which you assume the role of a parent to another (from infant to 21-year-old young individual) who has been initially placed in foster care. Once the adoption is finalized, all legal rights and responsibilities are transferred to you, the adopting parent, permanently.
Coping with an ovarian cancer diagnosis and treatment can be difficult enough, let alone having to deal with the emotions of starting a family. You may be feeling overwhelmed with information regarding your cancer treatment, but you should talk with your doctor or a reproductive specialist on approaches to preserving your fertility before starting your cancer treatment. Even though you may be preoccupied trying to deal with the effects of cancer and you may have not even decided if you want to have children in the future, it is necessary to have the conversation because your options will greatly diminish after your cancer treatment begins.
After cancer treatment
After finishing cancer treatment, you may find yourself expressing feelings of anger, frustration or sadness. Give yourself some time to process your feelings, but do not keep them bottled inside. You may find it helpful to speak to a friend, loved one or a professional counselor, allowing you to explore your feelings in a safe space. While it is natural to be concerned about how ovarian cancer might affect your fertility, you do have options.
In vitro maturation shows promise
There are also several new methods in experimental phases and one method in particular, known as in vitro maturation, is showing great promise for the future. In vitro maturation (IVM) involves harvesting immature eggs from an ovary, maturing them in a laboratory. and then freezing them. Once the eggs have matured, they are manually fertilized using a direct injection of sperm. Once they have had time to develop, they are transferred back into the womb. New advancements in the world of medicine have made motherhood after ovarian cancer a possibility. Learn which options are right for you so that you are able to make an informed decision that you will be content with.
References
https://www.targetovariancancer.org.uk/information-and-support/younger-women/fertility
https://www.ksat.com/health/saving-fertility-after-cancer
https://ocrfa.org/patients/young-women/fertility-fertility-preservation/
https://utswmed.org/medblog/cancer-fertility-preservation/
