FERTILITY PRESERVATION OPTIONS IN WOMEN:

STANDARD OPTIONS INCLUDE

Embryo freezing -Embryo freezing involves the freezing and storing of embryos obtained by ovarian stimulation, egg retrieval, in vitro fertilization and freezing of embryos for later implantation (In married women and in women with a steady partner) Read More

Who is Eligible?

Post-pubertal to pre-menopausal female (ages ~15-45) who are willing to use partner or donor sperm to create embryos and who are willing to store frozen embryos are appropriate candidates for this option.

What are the Potential Risks/Concerns?

There is a risk hormones administered for ovarian stimulation will elevate estrogen levels. Medications such as aromatase inhibitors can be given to lower estrogen levels in women with hormone-sensitive tumors or with a history of DVT/PE. This process takes 2 to 3 weeks.

Future Use and Success Rates

When ready to attempt pregnancy, the frozen embryos are thawed and transferred to the uterus of the patient or, in some cases, a gestational carrier. If the patient does not have adequate ovarian function at the time of the planned transfer, she can be given hormones for about three weeks before the transfer and three months after to support the pregnancy. Embryo freezing is a highly successful technique that has been in use for more than 25 years. Nationwide, pregnancy rates for frozen embryo cycles range from 42.4% for women under 35 and 17.8% for women over 40 years.

Egg freezing (also known as oocyte vitrfication)-Harvesting and freezing of unfertilised eggs especially in young girls and when there is no steady partner. Read More

Who is Eligible?

Post-pubertal to pre-menopausal females (ages ~15-45) can consider egg freezing for fertility preservation. Typically, single patients who do not have a spouse or male partner are most interested in egg freezing, because there is no sperm needed for fertilization (as is the case for embryo freezing).

What are the Potential Risks/Concerns?

There is a risk hormones administered for ovarian stimulation will elevate estrogen levels. Medications such as aromatase inhibitors can be given to lower estrogen levels in women with hormone-sensitive tumors or with a history of DVT/PE. This process takes two to three weeks.

Future Use and Success Rates

When ready to attempt pregnancy, the frozen eggs are thawed and fertilized. The resulting embryos are transferred to the uterus of the patient or a gestational carrier. If the patient does not have adequate ovarian function at the time of the planned embryo transfer, she can be given hormones for about three weeks before transfer and three months after to support the pregnancy. Egg freezing is no longer considered experimental according to the American Society for Reproductive Medicine. Success rates in young women closely follow those seen with embryo freezing and are directly related to the age of the patient when she froze her eggs.

Radiation Shielding of Gonads- Use of shielding to reduce scatter radiation to the reproductive organs

Fertility-Sparing Surgeries

For appropriate cases of early-stage gynecologic cancers, certain conservative treatments to preserve fertility may be considered:

  1. Radical trachelectomy for cervical cancer
  2. Unilateral oophorectomy for ovarian cancer
  3. Progestin therapy for endometrial cancer

For women seeking fertility preservation under these circumstances, referral to a gynecologic oncology surgeon is recommended.

Ovarian Transposition-Surgical repositioning of the ovaries away from the radiation field to reduce the radiation exposure. Ovarian transposition is generally performed using a minimally invasive surgical procedure. Read More

Who is Eligible?

Patients who will be receiving pelvic radiation treatment and whose ovaries are situated within the planned treatment field may want to consider this procedure. Ovarian transposition is an option for women with a planned cancer treatment that carries high risk of infertility due to radiation. It is an option for pre-menopausal females who do not have adequate time for egg or embryo freezing, and for pre-pubertal females who are not able to undergo ovarian stimulation and egg retrieval.

What are the Potential Risks/Concerns?

This procedure carries risks for complications from anesthesia and typical risks associated with any invasive procedure, including bleeding and infection.

Future Use and Success Rates

The retention of ovarian function using ovarian transposition is not guaranteed and patients should be offered egg or embryo freezing before treatment if there are no medical contraindications. If the fallopian tubes are resected, the patient will not be able to conceive naturally. Instead the patient would need to undergo ovarian stimulation and trans-abdominal egg retrieval. Alternatively, ovaries may be re-positioned after finishing RT in order to place them back into the pelvis for traditional IVF egg retrieval. If the uterus is exposed to a high dose of radiation during treatment, the patient may not be able to carry a pregnancy herself and may have to use a gestational carrier.

Ovarian transposition will not protect the ovaries from the effects of systemic chemotherapy.

EXPERIMENTAL OR NON STANDARD OPTIONS INCLUDE:

Ovarian Tissue Freezing - Freezing of ovarian cortical tissue and reimplantation after cancer treatment. This tissue holds primordial follicles, each containing a single immature egg. Read More

Who is Eligible?

Pre-menopausal females who do not have adequate time for egg or embryo freezing and pre-pubertal females who are not able to undergo ovarian stimulation and egg retrieval may want to consider this option. Women choosing ovarian tissue freezing have a planned cancer treatment regimen that carries a high risk of infertility.

What are the Potential Risks/Concerns?

There is a risk of complications from anesthesia. To minimize this risk, ovarian tissue freezing may be scheduled with another procedure requiring anesthesia. Invasive procedures also carry a risk of infection. To minimize this risk, a patient may be given prophylactic antibiotics. There is also a potential risk of reseeding cancer cells when ovarian tissues are re-implanted. Ovarian tissue freezing is only available at selected reproductive endocrinology centers.

Future Use and Success Rates

Ovarian tissue freezing is an experimental procedure. As such, it should be done under the approval of an Institutional Review Board. About 30 babies have been born world-wide using re-implantation of tissue in the pelvic region. While methods of maturing the immature eggs in the stored tissue in the lab are being studied, there have been no births to date using this approach (known as in vitro maturation).

Ovarian Suppression - Gonadotropin Releasing Hormone (GnRH) Agonists or Antagonists are used to suppress the recruitment of follicles to undergo maturation, to minimize blood flow to the ovaries, or to potentially directly protect eggs within the ovaries. Read More

Who is Eligible?

Post-pubertal to pre-menopausal females who are planning for gonadotoxic chemotherapy (not protective with radiation exposure).

What are the Potential Risks/Concerns?

This procedure will cause menopausal like symptoms, which may be intolerable for some patients; add-back therapy may alleviate some of these symptoms. The use of GnRH agonist will decrease bone density but this is largely reversible if used for no longer than six months.

Future Use and Success Rates

Ovarian suppression is an experimental procedure. It has been studied primarily in women with breast cancer and lymphoma and results evaluating effectiveness in preserving fertility are conflicting. The retention of ovarian function is not guaranteed and patients should also be offered egg or embryo freezing before treatment if there are no medical contraindications.