Female options before cancer treatment

What this is

• when no method is used to try and preserve fertility

When this is used

• when you don’t have time to consider fertility preservation
• when you choose to start cancer treatment immediately

How this works

• requires no action

What to consider

• more likely to lead to premature ovarian insufficiency

Pregnancy rate

• depends on age and cancer treatment

What this is

• the process of collecting, developing and freezing eggs or embryos as part of an in-vitro fertilisation (IVF) cycle

When this is used

• when you want to store eggs or embryos for use in the future – they can be stored for many years
• when you are ready to have a child, the frozen egg will be fertilised using IVF or the embryo will be implanted in your uterus

How this works

• egg and embryo freezing is part of IVF – the most common and successful assisted reproductive technology for preserving female fertility
• one cycle of IVF can take 2–3 weeks
• egg collection is done in an operating theatre as a day procedure

What to consider

• need time to have IVF before cancer treatment – your cancer specialists will advise how quickly treatment should begin
• ask the fertility clinic about the cost of storing eggs and embryos
• need sperm from a partner or donor sperm to create an embryo
• to use a frozen embryo, you will need consent from the sperm donor
• talk with your fertility specialist about whether to freeze eggs, embryos or a mix of both
• legal limits on how long eggs and embryos can be stored are different in each state and territory; ask the fertility clinic for details

Pregnancy rate

• freezing eggs works nearly as well as freezing embryos
• for every 10 eggs frozen, you can expect to get 1–4 embryos
• depending on age, the success rate of the fertility clinic and the stage at which the embryos are stored at, there may be a 25–40% chance per cycle of a frozen embryo developing into a pregnancy

What this is

• the process of removing, slicing, freezing and storing tiny pieces of tissue from an ovary so it can be used later

When this is used

• if treatment needs to start immediately
• if taking hormones to encourage egg production is unsafe
• if there is a high risk of infertility
• if the person hasn’t gone through puberty
• can be used in addition to egg freezing

How this works

• tissue is removed from your ovaries during keyhole surgery (laparoscopy); if you have abdominal surgery as part of cancer treatment, tissue can be removed at this time
• tissue is frozen until it is needed
• when needed, the tissue is thawed and put back (grafted) into the ovary
• tissue may produce hormones and eggs may develop

What to consider

• risk that storing tissue before treatment begins means it will contain cancer cells, and you may not want to put this tissue back into your body; risk is higher for people with leukaemia
• legal limits on how long ovarian tissue can be stored are different in each state and territory
• ask your fertility clinic how much you will have to pay for storage

Pregnancy rate

• there have been a small number of births worldwide from ovarian tissue removed after puberty, and several births from ovarian tissue removed before puberty
• about a third of people who have tried to use ovarian tissue to become pregnant have been successful

What this is

• surgery that moves one or both ovaries to prevent damage to the ovaries during radiation therapy

When this is used

• when one or both ovaries are in the path of radiation therapy
• limits how much radiation the ovaries receive

How this works

• one or both ovaries are moved away from the field of radiation and stitched in place
• put back in place after radiation therapy ends

What to consider

• procedure may cut off blood supply, causing damage to the ovaries

Pregnancy rate

• depends on your age, the amount of radiation that reaches the ovaries and if you start menstruating again

What this is

• trachelectomy removes part or all of the cervix and keeps the uterus, fallopian tubes and ovaries in place
• unilateral-salpingo oophorectomy removes only 1 ovary

When this is used

• trachelectomy is for small tumours found only in the cervix
• unilateral-salpingo oophorectomy is for early-stage cancer found only in 1 ovary

How this works

• the uterus is stitched tight with a small opening to allow blood to pass out during a period and for sperm to enter

What to consider

• risk of miscarriage and premature birth; may have a stitch placed in what remains of the cervix to reduce the risk

Pregnancy rate

• number of births increasing

What this is

• gonadotropin-releasing hormone (GnRH) analogue is a long-acting hormone that stops the ovaries making oestrogen for a short time
• may protect eggs from being damaged

When this is used

• at least 1 week before chemotherapy starts, continuing until chemotherapy finishes

How this works

• hormone injections given 7–10 days before chemotherapy starts or during the first week of treatment, then every month or every 3 months during chemotherapy

What to consider

• backup to other fertility preservation options
• can affect bone density if used for more than 6 months

Pregnancy rate

• studies show that treatment is suitable for young women with breast cancer but there is no evidence for other types of cancer