The best way to reduce the risk of fertility loss from cancer treatment is to preserve your fertility prior to starting chemotherapy, radiation, or surgery.These options include:

Egg Banking: Egg banking is an experimental technique that consists of hormonal stimulation to mature many eggs in a woman, followed by retrieval and freezingof the eggs. Prior to the procedure, women undergo hormone therapy for 2-3 weeks in order to mature multiple eggs. Medical professionals then recover the eggs in an outpatient procedure and freeze them for later use. Once a woman is ready to have a child, the eggs can be thawed, fertilized by sperm through in vitro fertilization (IVF), and implanted into her uterus. Women who are single or do not desire to use donor sperm to fertilize their eggs often find egg banking to be a viable option.
Embryo Banking

Embryo banking: This technique is similar to egg banking but is more established. During egg banking, after hormonal stimulation and egg retrieval, the eggs are fertilized with sperm through in vitro fertilization (IVF) prior to freezing. The one or two-cell embryo is then frozen down for later thawing and uterine implantation when the woman is ready to have a child. Women can use the sperm of a partner or donor sperm to fertilize the eggs.

Ovarian tissue banking: This experimental fertility preservation option involves removing an ovary or piece of ovary and freezing the tissue for later use. When a woman is ready to have biological children, pieces of the ovarian tissue can be reimplanted and may begin producing mature eggs. This may be an option for women who cannot delay cancer treatment for hormonal stimulation of egg and embryo banking or prepubertal girls. In addition, researchers are working to grow the immature follicles from ovarian tissue to a point where they can be fertilized outside the body, which would provide fertility preservation options for more young cancer survivors.

Additional options also exist for women and girls to preserve their fertility prior to cancer treatment. The FERTLINE national fertility hotline (866/708-FERT, oncofertility@northwestern.edu) has experienced fertility preservation patient navigators, who can explain these options and help patients find a reproductive specialist near them.

Yes. Alkylating chemotherapies, such as cyclophosphamide, busulfan, procarbazine and melaphan, put women at high-risk for fertility loss after cancer. Alkylating agents can damage the resting pool of immature follicle, called the ovarian reserve, which may cause immediate infertility or premature infertility in women and girls. In contrast, nonalkylating chemotherapies such as vincristine, methotrexate and bleomycin, are less likely to cause permanent infertility in younger patients.

In addition to chemotherapy, radiation and surgical cancer treatments may cause infertility in young cancer survivors. Radiation to the pelvis, abdomen, or whole-body radiation put women at particularly high risk for later infertility by damaging the ovaries and uterus, as well as the blood supply to these organs. High levels of cranial irradiation can also impact future fertility since the brain directs much of the precise hormonal signaling required for fertility. Finally, surgeries of the abdomen and pelvis may affect fertility or the ability for a woman to carry a pregnancy to term.

Several types of treatments exist to cause a woman to mature multiple eggs prior to retrieval for egg or embryo banking. Hormonal stimulation includes treatment with follicle stimulating hormone (FSH), which helps the ovaries to develop multiple follicles, or immature eggs, for fertilization. Prior to retrieval, a single shot of human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) is given to mature the egg for fertilization. Additional treatments, such as aromataseinhibitorsmay be given to women, such as those with hormone sensitive cancers, to reduce estrogen levels during ovarian stimulation.

Insurance coverage for fertility preservation can vary depending on your state and insurance company. In addition, the way your fertility doctor codes your treatment can affect whether your insurance company approves the bill. Billing resources for providers and patients can be found on the Oncofertility Consortium’s website (http://oncofertility.northwestern.edu/health-professionals/fertility-preservation-billing-resources). Fertility preservation specialists at the FERTLINE (866/708-FERT) also have experience working with national insurance providers to get fertility preservation covered for cancer patients.

For women who do not have insurance coverage or those whose insurance does not cover fertility preservation, some non-profit organizations help to cover the cost of fertility preservation for young cancer patients and survivors. Fertile HOPE covers sperm banking services and some storage fees for eligible male patients. In addition, ovarian stimulation medications and egg or embryo banking fees may be covered for eligible women. Similarly, Fertile Actionworks with fertility specialists to get fertility preservation services waived for young cancer patients.

The American Society for Reproductive Medicine (ASRM) is the major professional organization representing fertility specialists and members of ASRM are required to submit their annual assisted reproductive technologynumber and success statistics to the Society for Assisted Reproductive Technology, or SART. SART publishes this information on it’s website (http://www.sart.org). National and clinic-specific data on IVF success rates is publicly available. Fertility preservation patients should note that these statistics are for all patients, not just cancer patients. As these statistics may be a bit overwhelming, young cancer patients and their families may prefer to contact the national fertility FERTLINE hotline (866/708-FERT, oncofertility@northwestern.edu) whose patient navigators can also direct them to reputable clinics.

1. Will my cancer or its treatment affect my future fertility?
2. What fertility preservation options are out there?
3. Which options are best for me?
4. Do any of these options make my cancer treatment less effective or raise the chance of a recurrence?
5. I am not in a relationship but still want a child; what are my options?
6. Can I have a child after cancer?

Additional questions to bring to a doctor’s office can be found athttp://MyOncofertility.org orhttp://SaveMyFertility.org.

Many fertility specialists around the country have now learned how to best modify their programs for the unique needs of young cancer patients. Many of these providers are members of the National Physicians Cooperative, a nationwide network of fertility preservation centers. These experts participate in ongoing research on reproductive medicine and have a commitment to working with women to quickly incorporate reproductive concerns into the cancer treatment process. A map of these centers can be found athttp://oncofertility.northwestern.edu/find-a-center.

Many other fertility centers around the country have expertise and experience working with young cancer patients. The fertility preservation patient navigators at the national fertility hotline, the FERTLINE (866/708-FERT, oncofertility@northwestern.edu), are knowledgeable about these providers and can help young patients find the center closest to them that fits their needs.

Breast and ovarian cancer survivors, especially those with, hormone-sensitive cancers, may worry about using ovarian stimulating hormones either during fertility preservation prior to cancer treatment or during survivorship. For fertility preservation purposes, embryo or egg banking are options for many young women. In this process, hormones are used to induce the ovaries to produce multiple eggs in one month (normally an ovary produces a single egg per month). Clinical hormonal stimulation protocols have been modified to work for women with hormone-sensitive cancers. The one study that looked at cancer recurrence rates for breast cancer survivors who underwent this procedure, found that these women did not have an increased risk for cancer recurrence compared to those who did not have ovarian stimulation.

Survivors of hormone-sensitive cancers may also discuss using this protocol with their fertility specialist. However, they may first wish to examine their ovarian reserve, the number of immature eggs in their ovaries, as chemotherapy, radiation, and surgery for cancer treatment may have significantly reduced this number.