What fertility preservation options do I have before starting cancer treatment?

Recently, fertility specialists and scientists in the UK achieved another milestone. They reported the first successful birth of a healthy baby from the transplanted ovarian tissue in a cancer survivor.

The woman had a part of her ovary frozen before starting her cancer treatment. Following successful completion of the treatment, the frozen ovarian tissue was transplanted back. There are forty such reported births around the world, and this is the first in the UK.

In June, at the European Society of Human Reproduction and Embryology meeting in Helsinki, Oxford scientists reported obtaining ovarian tissue from a two-year-old child who was diagnosed with cancer and freezing the tissue. They also reported collecting immature eggs. The eggs were then taken through the maturation process and frozen. This was not only part of a research project, it was a significant development in improvising fertility preservation methods for cancer patients.

Scientists have been working on this for many years, and there are still challenges to overcome. Fertility preservation is one of the few ways that cancer survivors can be a biological parent upon successful completion of the cancer treatment.

Cancer treatments, such as chemotherapy or radiotherapy can affect fertility in the long term. However, not every cancer patient who hasn’t completed their family is offered an opportunity to discuss fertility preservation.

Having read this report, I thought of sharing the different aspects of fertility preservation for female cancer patients. At London IVF and Genetics Centre, we are committed to simplifying complex fertility science and helping our patients make informed decisions.

How do cancer treatments affect female fertility?

Most cancers are treated with surgery, chemotherapy or radiotherapy either alone or together. Chemo and radiation treatment can affect the female fertility by damaging the eggs in the ovaries. This damage results in reduced ovarian reserve or ovarian failure.

Patients, both children and adults who need stem cell transplant with whole body radiation are most likely to experience an impact on their fertility or experience premature ovarian failure in the long term. The ovaries generally tolerate cancer treatments better than the testes.

The effect of the treatments on ovarian reserve is dependent on the age of the woman when being treated. A woman who is 30 or 40 years old is more likely to suffer infertility compared to an adolescent girl.

In some patients, the lining of the womb may be damaged by radiation treatment if the pelvis has been exposed to radiation treatment. This can make the womb less capable of successful implantation of the fertilised embryo, which may lead to failure of implantation or miscarriage. The effect of cancer treatment can be both on the egg health, ovarian reserve, and the lining of womb.

There is a chance that the fertility may be restored in some patients after the completion of the cancer treatment. Some women may resume their menstrual cycles and ultimately their fertility. However, this varies from patient to patient and will more certain with time.

There are no reliable tests that can help fertility specialists in predicting the likelihood of fertility restoration in patients before they start cancer treatment. These tests can be arranged once you have completed cancer treatment and are thinking of getting pregnant.

There are a few options which you may consider before starting cancer treatment. If you are an adult and in a relationship, then you can consider freezing of the embryos using your partner’s sperms. Embryo freezing has been in practice since 1980’s.

If you are not in a relationship, then you can consider freezing your eggs. Both of these options are commonly available through most fertility clinics in the UK.

The NHS funds egg and embryo freezing as part of fertility preservation. Your oncologist or nurse specialist can apply to secure NHS funding for fertility preservation. However, they may have some criteria that some patients may not be eligible for the NHS funding for fertility preservation. Some cancer specialist may prescribe you certain injections (GnRH analogues) that stop your eggs from dividing and protects them from the toxic effects of the chemotherapy drugs.

For adolescent girls, the options would be either freezing of their eggs or a small part of their ovary. Few clinics may have the facility for managing such patients. The major challenge is for pre-pubertal young girls, who may have to consider freezing ovarian tissue.

Freezing a part or the entire ovary is still very experimental. There will be only a handful of specialised centres that may be able to offer this as a fertility preservation option. There is a possibility you have to travel to a clinic or hospital outside your area.

Most cancer specialists are aware and will routinely discuss this with you. Sometimes, it may depend on the extent of cancer and whether there is any time beforehand to complete egg freezing, embryo freezing, or freezing ovarian tissue.

If this has not been mentioned, then you should not hesitate in bringing this up with your cancer specialist.

When considering fertility preservation before cancer treatment, patients are being given a lot of information. This is an emotionally difficult time so it may be difficult to take on board all that has been discussed.

When preserving fertility, the eggs, embryos or ovarian tissue can be stored for a total of fifty-five years according to the HFEA. The storage period is extended every ten years and has to be certified by the fertility specialist at your clinic.

When the storage period is coming to an end, your fertility clinic will contact you. You will have to complete the relevant consent forms to extend the storage of the eggs, embryos or ovarian tissue. You may have to pay for continued storage if NHS funding does not exist. The NHS funding for continued storage differs from postcode to postcode.

Therefore, it is important that you keep your contact details up to date with the clinic to ensure continued storage of the gametes or embryos. If you do not respond to the repeated contact attempts by your fertility clinic, then they will not be able to maintain storage of the frozen items.