Fertility: Risks & Options

Women

Men

Female Fertility Preservation Risks:

Normal Female Fertility & the Negative Impact of Cancer Treatment
Normal Female Fertility & the Negative Impact of Cancer Treatment

Male Fertility Preservation Risks:

Normal Male Fertility & the Negative Impacts of Cancer and Cancer Treatment
Normal Male Fertility & the Negative Impacts of Cancer and Cancer Treatment

Female Fertility Preservation Options:

Female Fertility Preservation Options: Egg and Embryo Banking
Egg and Embryo Banking
Female Fertility Preservation Options: Ovarian Tissue Cryopreservation
Ovarian Tissue Cryopreservation
Option Definition Timing Time Requirement Other Considerations

Embryo Banking

 

 Ovarian stimulation; Harvesting eggs, IVF and freezing of embryos Before or after treamtment 10-15 days outpatient surgical procedure Need partner or sperm donor
Egg Banking  Ovarian stimulation; Harvesting and freezing of unfertilized eggs Before or after treamtment 10-15 days outpatient surgical procedure  
Ovarian Tissue Banking (Experimental) Surgical removal of ovarian tissue and processing of tissue for freezing Before or after treamtment Outpatient surgical procedure Autotransplantation of tissue has produced live births; studies ongoing for IVFM
Radiation Shielding Use of shielding to reduce scatter radiation to the ovaries During treatment  In conjunction with radiation treatments Does not protect against effects of chemotherapy
Ovarian Transposition Surgical reposition of ovaries out of radiation field Before treatment Outpatient procedure  
Radical Trachelectomy Surgical removal of the cervix with preservation of the uterus Before treatment  Inpatient surgical procedure Limited to early stage cervical cancer
Ovarian Suppression (Experimental) GnRH analogs used to suppress ovaries During treatment  In conjunction with chemotherapy Data are mixed on the effectiveness of this option.

Male Fertility Preservation Option:

What is the sperm-banking procedure?
Sperm-Banking

Decision Tree

This decision tree can help you explore options for family building before, during and after treatment. If you are looking at this on behalf of someone else (i.e. you are a parent, partner or loved one), answer the questions based on your child, partner or loved one, not based on yourself.

Some cancers affect the health of sperm before treatment beings. Men with cancer may have a low sperm count, abnormally shaped sperm and sperm with reduced motility. Sometimes life-saving treatment for your cancer can negatively affect your fertility. Certain treatments like chemotherapy can impair the testicle’s ability to produce healthy sperm, damage the structures that are needed to ejaculate and reduce the level of hormones that come from the brain to stimulate sperm production. Not all cancer treatments cause problems with fertility, each patient is unique. Problems with fertility may be temporary or permanent. It is impossible to know exactly how you will be affected.

BEFORE Cancer Treatment

Testicular Tissue Cryopreservation
Testicular Tissue Cryopreservation is an experimental option available at a few institutions in the country. In this process, a portion of the testicle is surgically removed and the tissue is cryopreserved. Advances in reproductive biology might eventually allow germ cells from an immature testis to be used in fertilization in the future.

DURING Cancer Treatment

Testicular Tissue Cryopreservation
Testicular Tissue Cryopreservation is an experimental option available at a few institutions in the country. In this process, a portion of the testicle is surgically removed and the tissue is cryopreserved. Advances in reproductive biology might eventually allow germ cells from an immature testis to be used in fertilization in the future. It should be noted that chemotherapy and radiation therapy can damage sperm and sperm-making cells. It is unknown whether this type of damage would cause neonatal malformations in offspring. It is always best to preserve fertility before any gonadotoxic therapy has begun.

AFTER Cancer Treatment

Semen Analysis
A simple semen analysis would be the best way to determine any fertility damage that you might have endured as a result of your treatment. Once you are able to ejaculate, you can have a semen analysis that will let you and a reproductive urologist know exactly how much, if any, damage has been done to your fertility. A reproductive urologist can help you look at options for family building.

BEFORE Cancer Treatment

Sperm Banking
Sperm Banking is the most widely used process for fertility preservation before treatment. In order to sperm bank, you need to produce a semen sample. This usually involves masturbating into a sterile cup or using certain tools to provide a sample. Once the semen is collected, it is analyzed, cryopreserved and held in special tanks. The number of specimens you need to produce will depend on the amount and quality of your sperm. If possible, it's recommended that you make multiple collections to ensure you have enough healthy sperm to store. Do not have sexual activity 48 hours before providing a semen sample.

Testicular Sperm Extraction is an outpatient surgical procedure available for patients who don’t have viable sperm in their semen. A small portion of tissue from the testicle is extracted and any viable sperm cells present in that tissue are removed and cryopreserved. Sperm can be retrieved in this manner in about 50% of cases.

DURING Cancer Treatment

Sperm Banking
Sperm banking is the most widely used process for fertility preservation before treatment. In order to sperm bank, you need to produce a semen sample. This usually involves masturbating into a sterile cup or using certain tools to produce a sample. Once the semen is collected, it is analyzed, cryopreserved, and held in special tanks. The number of specimens you need to produce will depend on the amount and quality of your sperm. If possible, it's recommend that you make multiple collections to ensure you have enough healthy sperm to store. Do not have sexual activity 48 hours before providing a semen sample. Chemotherapy can alter the DNA of sperm and the effects of this on offspring are unknown. It is important to try to bank sperm prior to the initiation of chemotherapy.

Testicular Sperm Extraction
Testicular Sperm Extraction is an outpatient surgical procedure available for patients who don’t have viable sperm in their semen. A small portion of tissue from the testicle is extracted and any viable sperm cells present in that tissue are removed and cryopreserved. Sperm can be retrieved in this manner in about 50% of cases. Chemotherapy can alter the DNA of sperm and the effects of this on offspring are unknown. It is important to try to bank sperm prior to the initiation of chemotherapy.

AFTER Cancer Treatment

Semen Analysis
A Semen Analysis would allow an andrologist to analyze your sperm and determine if there are sperm present within your semen. A reproductive urologist can help you explore options if no sperm are present or third party reproduction options like donor sperm and adoption.

Many structures of the body are involved in conceiving a child. These include the ovary, fallopian tubes, uterus and glands in the brain that secrete hormones. When a woman is born, her ovaries contain between one and two million follicles. Each follicle contains a single immature egg (oocyte). During a woman’s lifetime, these follicles break down and decline in number. At puberty, hormones from the brain stimulate the monthly menstrual cycle to begin.

Cancer treatments can prematurely reduce the amount of healthy eggs and follicles in your ovaries. This damage can cause you to stop menstruating and even go into premature menopause. Each patient can be affected differently based on age at diagnosis, treatments received and personal fertility. Fertility options will be different for each patient.

BEFORE Cancer Treatment

Ovarian Tissue Banking
Ovarian Tissue Banking is an experimental option. A portion or one entire ovary is surgically removed and cryopreserved for future use. There are two ways a woman may be able to use her frozen ovarian tissue in the future: ovarian tissue transplantation and in vitro follicle maturation. In an ovarian tissue transplant, a surgeon thaws the frozen cortical strips and transplants them back into the patient with the hope that immature follicles within the transplanted strips will begin to develop as they would in a normal ovary. To date, this has resulted in about 15 live births around the United States. In vitro follicle maturation is a technique that scientists at Northwestern are actively studying. This technique would involve allowing the eggs within the immature follicle to grow and mature outside of the body. This method is not yet available for patients.

DURING Cancer Treatment

Ovarian Tissue Banking
Ovarian Tissue Banking is an experimental option. A portion or one entire ovary is surgically removed and cryopreserved for future use. There are two ways a woman may be able to use her frozen ovarian tissue in the future: ovarian tissue transplantation and in vitro follicle maturation. In an ovarian tissue transplant, a surgeon thaws the frozen cortical strips and transplants them back into the patient with the hope that immature follicles within the transplanted strips will begin to develop as they would in a normal ovary. To date, this has resulted in about 15 live births around the United States. In vitro follicle maturation is a technique that scientists at Northwestern are actively studying. This technique would involve allowing the eggs within the immature follicle to grow and mature outside of the body. This method is not yet available for patients. This animation helps describe this process: Ovarian Tissue Cryopreservation

Chemotherapy and radiation therapy can damage DNA within gamete cells and the effects of this on future offspring are unknown. It is best to try to bank tissue before chemotherapy and radiation therapy.

AFTER Cancer Treatment

Hormonal Testing
Hormonal testing is available for patients to determine if treatments have had an impact on your fertility. A reproductive endocrinologist is available to help determine which tests would be most beneficial and to interpret those tests appropriately.

BEFORE Cancer Treatment

Embryo Banking
Embryo Banking is an assisted reproductive technology that can take almost a month to complete. This requires a reproductive endocrinologist to use fertility drugs to stimulate your ovaries to recruit and mature multiple eggs at once (instead of the one egg that you normally recruit and mature in a monthly menstrual cycle). After 8-13 days of medication, you will be ready for a retrieval, an outpatient procedure. Once the eggs are out of your body, an embryologist will fertilize the eggs with sperm (either a partner’s or donor’s) and wait for one day to determine if the eggs were successfully fertilized. The embryos are then cryopreserved for future use when you’re ready to have a family. In the future, when you are ready to use these embryos, they will be thawed and transferred to your primed uterus.

Egg Banking
Egg Banking is an experimental assisted reproductive technology that can take almost a month to complete. This requires a reproductive endocrinologist to use fertility drugs to stimulate your ovaries to recruit and mature multiple eggs at once (instead of the one egg that you normally recruit and mature in a monthly menstrual cycle). After 8-13 days of medication, you will be ready for a retrieval, an outpatient procedure. Once the eggs are out of your body, an embryologist will freeze the eggs. In the future when you’re ready to try to have a family, these eggs can be thawed, fertilized with sperm, and the subsequent embryo can be transferred to your primed uterus.

DURING Cancer Treatment

Hormone Therapy
Hormone Therapy is an experimental option where your physician can give you a medicine called a gonatropin releasing hormone analogue. The most common drug used is called Leuprolide Acetate (Lupron). This medication is given ideally two weeks before you begin your chemotherapy. It will continue the entire time you are on therapy. Many studies are ongoing to determine the effectiveness of this medicine but we don’t currently know for certain that it can protect your ovarian reserve. This medicine will cause to go into a medical menopause with the theory that if your ovaries are quiescent, there won’t be as much damage from the treatments. Patients will sometimes choose this option along with another fertility preservation option.

AFTER Cancer Treatment

Hormonal Testing
A reproductive endocrinologist (RE) can meet with you after you've finished treatment to determine if your ovaries havebeen damaged by your treatment. An RE will want to obtain hormone levels and possibly do a transvaginal ultrasound to look at your ovaries. These tests combined can help the RE determine which options for family building will be best.

In certain circumstances, you may be able to attempt to get pregnant naturally. If that isn’t an option or if that doesn’t work, you can look into assisted reproductive technologies (ART) like intrauterine insemination (IUI) and in vitro fertilization (IVF) or third party options like donor eggs or adoption.

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