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Preserving fertility after a cancer diagnosis

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According to the American Cancer Society, approximately 70,000 women of reproductive age are diagnosed with cancer each year. This can be an overwhelming time, and many people feel fear and anxiety.

Yet cancer treatments have improved drastically in the last decade. The five-year overall survival for all cancers combined is now over 70%. Many cancers are curable.

For this reason, women with cancer must look forward to and plan for the future. If you wish to have children, it’s important to ask your health care provider about your future fertility and ways to keep your options open (fertility preservation).

What treatments might impact my fertility?

There are many different types of cancer treatment, and some impact fertility more than others. Recently, many more cancer treatments have become available as pills or are immunotherapy. Since these are new, less is known about their fertility effects. Treatments that pose the highest risk to fertility include stem cell transplant and total-body irradiation. Some cancers require ongoing maintenance treatments, often with oral medications.

With so many different effects and treatment timelines, it’s important to ask your health care provider about your individual risk for infertility with your cancer treatments. Make sure to check with your provider before considering pregnancy while on oral cancer medications. There may be options to safely take a break from medication to allow for a healthy pregnancy.

What are my options?

The gold standard for fertility preservation is egg (oocyte) or embryo freezing (cryopreservation). Options include the following:

  • Your eggs can be harvested and frozen for future fertilization.
  • Your eggs can be harvested and fertilized with partner or donor sperm (embryo) and then frozen.

For either process, you usually receive medications over 5 to 10 days to stimulate egg release. Eggs are then retrieved with ultrasound guidance and processed. This generally takes 2 to 3 weeks.

Many women do not have 2 to 3 weeks to wait before their cancer treatment begins. Frequently, hormonal suppression is used to try to protect future fertility in these cases.

Hormonal suppression is most often achieved with leuprolide acetate (Lupron Depot) by injection every 1 to 3 months. The hormone places the ovaries into a state of hibernation and suppresses ovulation, thus theoretically protecting eggs from chemotherapy damage. Hormonal suppression is not approved by the Food and Drug Administration for fertility preservation. This option may not be appropriate for hormone-responsive cancers such as many breast and ovarian cancers.

Less common fertility preservation options that may be offered include:

  • Ovarian transposition. Ovaries can be surgically moved away from a field of radiation to avoid damage.
  • Ovarian tissue cryopreservation. Part or all of an ovary can be surgically removed and frozen for future reimplantation. This is experimental, but it might be the only option for young girls who have yet to go through puberty.

Will my insurance pay for fertility preservation?

Insurance coverage varies. Much of the time, fertility preservation is not covered. Infertility treatments might be covered to some degree, but fertility preservation is separate and often considered preventive. The upfront cost of embryo or oocyte cryopreservation can be around $5,000. The yearly storage fees can range from $200 to $1,000.

Fortunately, there are resources for people with cancer that provide financial assistance for fertility preservation:

  • LIVESTRONG. This organization provides free fertility meds and discounted storage.
  • Verna’s Purse. This organization provides discounted storage.

What if none of those choices is an option for me?

If the above options for fertility preservation are not feasible for you, don’t lose hope! There are still ways to have a beautiful family. Surrogacy and adoption are available to everyone.

Now that you’re better informed of your options, you can feel empowered to talk to your health care provider and advocate for your future family!

Jennie Goble, PA-C

Jennie Goble, PA-C is a Physician Assistant in Hematology at Mayo Clinic in Rochester, MN. She has a special interest in cancer supportive care, sexual health, and fertility preservation.

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