Fertility Preservation After Cancer Diagnosis (Oncofertility): a Guide for Men & Women
If you’ve been diagnosed with cancer, protecting your future family starts now
Cancer treatment such as radiation and chemotherapy can save your life but also damage fertility, particularly a woman’s eggs or a man’s sperm, the building blocks of pregnancy.
Fertility preservation: a key step in your cancer treatment plan
Time is of the essence so schedule a conversation with one of our fertility specialists today.
Call us: 423-509-8094
- Call to request an appointment and let us know you are a cancer patient so we can prioritize your fertility preservation consultation. Ask about same-day appointments ahead of urgent cancer treatment.
- Have your cancer diagnosis and treatment plan ready for us to review. You can have your oncologist fax your information to (423) 643-0699.
- We have accessible options, financial counseling, insurance coordinators and medication discounts.
Supporting your future family, today.
Fertility preservation before cancer treatment (oncofertility) overview
When patients receive a cancer diagnosis, concerns about fertility may not feel like the immediate priority – or even come to mind. But for many, the ability to have a family in the future is ultimately extremely important, and taking steps to protect your fertility ahead of or even during cancer treatment can preserve future family building options.
In the past, there were many barriers to patients taking steps to preserve their fertility. Doctors or patients were not always comfortable discussing fertility, and there were many misconceptions about the cost and the availability of procedures.
But if you’ve been diagnosed with cancer, protecting your future fertility starts now.
The goal of this guide is to help you work with a reproductive endocrinologist to help minimize the risks that cancer treatments pose to your ability to have children of your own.
Steps of fertility preservation after a cancer diagnosis
Once you receive a cancer diagnosis, treatment both for cancer and fertility preservation should be pursued right away. Both your oncologist (cancer doctor) and reproductive endocrinologist (fertility doctor) can work together swiftly on a treatment plan, typically giving you the following steps:
- Understand your cancer diagnosis.
- Create a cancer treatment plan.
- Meet with a TRM provider for fertility testing and a fertility preservation plan.
- Complete fertility preservation treatment and preventive measures (more details below).
- Begin (or resume) cancer treatment.
Risks of infertility from cancer treatment
Radiation and most chemotherapies work by targeting rapidly multiplying cells. This is why slowly dividing cells (such as brain tissues) are largely unaffected, but the cancer cells are destroyed. Sperm cells and some egg follicle cells are rapidly dividing, so they too can be affected by radiation and chemotherapy, thus damaging the patient’s ability to get pregnant.
Cancer treatments can be classified according to how likely they are to threaten fertility by: low, medium or high. The risk all depends on how the individual treatments affect germ cells:
- In men, germ cells in the testicles are destined to become sperm.
- In women, the germ cells have already become eggs in the follicles inside the ovaries.
Radiation to the ovaries or testicles, and certain chemotherapy agents, will destroy germ cells (future sperm) and eggs. Depending on the dose, the duration of treatment and the number of treatments, some treatments will destroy more eggs and sperm than others.
Some of these treatments pose a risk for immediate sterility (infertility), meaning the patient can no longer produce eggs or sperm. Alternatively, men may produce sperm in a limited manner after treatment, and women may go through premature menopause several years after treatment.
Younger women (patients in their 20s) may be somewhat protected against egg destruction, simply because they have more eggs in their ovaries compared with older women (patients in their late 30s). In fact, the older a woman is at the time of cancer treatment, the greater her risk of infertility or sterility. Age is less of a factor for men.
The person to best quantify the risk is your oncologist.
Fertility preservation options when facing cancer (oncofertility)
Fertility preservation (oncofertility) options for men
Men can produce a semen sample to allow for sperm to be stored for future use through sperm freezing (sperm cryopreservation). These samples can be obtained through masturbation or electrostimulation. Large numbers of sperm are not needed for men to attempt a pregnancy in the future, so frequently one collection is all that is required.
Lupron (leuprolide acetate) therapy, prior to or during cancer treatment, may also limit damage to sperm producing tissues.
Fertility preservation options for women
If treatments can be delayed for up to two weeks after cancer diagnosis, a woman can take medications that will stimulate the ovaries to produce multiple mature eggs at once (whereas the normal monthly cycle typically only produces one mature egg for ovulation).
A reproductive endocrinologist performs a minimally invasive, in-office procedure to remove the eggs, which are then stored for future use through egg freezing (egg cryopreservation).
If the cancer treatment results in the woman going through premature menopause, she can use her cryopreserved eggs at a later time to achieve pregnancy. Egg cryopreservation has excellent success rates to achieve pregnancy.
If cancer treatment cannot be delayed, it is still worthwhile discussing fertility preservation options with a reproductive endocrinologist, either at the time of diagnosis or soon after completing chemotherapy.
Embryo freezing & storage (cryopreservation)
If a cancer patient has a partner, he or she can elect to freeze multiple kinds of specimens: sperm for men, eggs for women and embryos, which are created by combining eggs and sperm through in vitro fertilization (fertilization in an IVF lab).
A cancer patient may also elect to create embryos using a donor; for example, a women can combine her eggs with donor sperm.
In the future, the embryo can then be implanted in a woman’s uterus to create a pregnancy.
Other fertility protection measures during cancer treatments
If radiation is part of the patient’s cancer treatment, sometimes the testes and ovaries can be shielded. For example, the ovaries can be moved out of the way so they receive a lower radiation dose.
Lupron is a drug used to temporarily decrease hormonal stimulation to the ovaries and testicles; this effectively “shuts down” the ovaries and testicles during chemotherapy. It may lead to decreased blood flow to these areas, and it might lessen the effects of chemotherapy in each ovary or testicle. Lupron has no long-term detrimental effects on the ovary or testicle.
Although testicular or ovarian tissue can be harvested, frozen and potentially returned to the patient after cancer treatment, these options have few success stories. Because of this, Tennessee Reproductive Medicine does not offer tissue banking. If you are interested in this, we can direct you to centers that provide this service.
Making a fertility preservation (oncofertility) appointment with TRM
Talk with your oncologist about fertility preservation and if you determine it’s appropriate, either of you may arrange a patient consultation with one of our fertility physicians.
If cancer treatment is urgent, we will make efforts to speak with you about your fertility preservation options immediately.
Cancer treatment & fertility preservation frequently asked questions
Q: What is the difference between infertility and premature menopause?
Infertility is diagnosed when a couple cannot conceive on their own (without treatment). The diagnosis is usually made after a couple has been trying to conceive for 12 months or more. There are many causes of infertility including low or absent sperm counts, no or irregular ovulation, or anatomic causes such as blocked fallopian tubes.
Premature menopause is a condition in which a woman has no eggs. Natural menopause occurs at age 51 on average, but women who have had chemotherapy or radiation may experience this decades earlier. Ovulation after menopause is uncommon, so women who experience premature menopause are usually also infertile.
Q: If I am having periods (menstruating) after cancer treatment, does this mean I am fertile?
Not always.
To get pregnant, women need to produce an egg (ovulate). Some women may have periods in the years following cancer treatment, but this does not always mean they are ovulating.
When a woman ovulates, she will either get pregnant and have no periods (menses) until she delivers, or she will fail to get pregnant and have a normal period (bleeding) about 14 days after ovulation. Because of this, some women assume that if they have a period, this means they also ovulated. However, some women do not ovulate but their ovaries produce enough hormones to allow the uterine lining to grow. If the lining grows too thick, part of it can begin to shed and this can mimic a normal period.
Q: How long can my eggs, sperm or embryo be frozen & stored (cryopreserved)?
Although no one really knows how long an egg, sperm or embryo will remain useable (viable) after being frozen, we do know the following:
- Frozen sperm have achieved pregnancy nearly 30 years after being frozen.
- Embryos have been used successfully as long as 20 years after they were frozen.
- Egg freezing technology is more recent, but has been considered standard treatment by the American Society for Reproductive Medicine (ASRM) since 2012, and frozen eggs have been used successfully since then.
Q: Will my health insurance cover the cost of fertility preservation?
We file what we can with each patient’s health insurance. If you have insurance coverage for fertility preservation, the cost can vary with your plan, or with your co-pay.
In the event that you don’t have coverage, we make every effort to make fertility preservation for cancer affordable. For egg cryopreservation, we can get the ovulation medications (which are expensive) donated by the drug manufacturers as part of fertility preservation programs.
Q: Do fertility preservation treatments increase my risk for cancer recurrence?
At this time, we have not seen evidence that these procedures change a patient’s prognosis for cancer recurrence.
Q: If I get pregnant after cancer treatment, do I have an increased risk of birth defects or health problems in the baby?
Patients who conceive with IVF do have a slightly higher rate of babies with birth defects compared with the general public, but the risk is relatively low (2.6%–5%). This is the same rate as other infertile patients who conceived without IVF, so it is likely that the increased risk is due to patient characteristics and not the procedure itself. The vast majority of babies born are healthy.
Q: Will it be safe for me to get pregnant later?
This is a conversation that your oncologist is most qualified to answer. Some chemotherapies can affect the heart, lungs, uterus or other organs. In these cases, pregnancies can be higher risk for both the mother and the baby.
