Your San Diego fertility center: Reproductive Sciences Center & Genetics Institute

Female Infertility Treatment Options for Women with Cancer

Advances in the treatment of cancer have led to impressive improvements in the long-term prognosis of female patients. Unfortunately, a major complication of these increasingly effective cancer therapies is reproductive failure resulting in the woman's temporary and even permanent infertility or sterility. We offer a range of technologies to help female cancer patients preserve their fertility. Reproductive Sciences Center has provided comprehensive fertility services to oncology patients for over 10 years.

Options for Women with Cancer

Combination chemotherapy regimens and radiotherapy commonly produce menstrual irregularities as well as infertility. Total-body irradiation used in the preparative regimens for bone marrow transplantation is damaging to endocrine and ovarian function. For young cancer patients wishing to preserve fertility there are now several options available including ovarian tissue cryopreservation and transplantation, egg freezing and embryo freezing. When choosing a cryopreservation technique, women must consult their oncologist and a reproductive endocrinologist to evaluate their individual medical and personal needs.

Commonly asked questions

Who are potential candidates for embryo freezing?
Women who have a partner, or wish to employ the use of donor sperm, are able to undergo in vitro fertilization before chemo- or radiotherapy and have their embryos frozen for a later embryo transfer.

What is the success rate of embryo freezing?
Although isolated pregnancies from egg freezing have been reported for many years, it is only recently that egg freezing can be performed with reproducible success resulting in reasonable survival rates (50-70%), fertilization rates (50-60%) and pregnancy rates approaching those obtained with fresh eggs. Embryo freezing is a well established procedure in most IVF laboratories, and generally results in reasonable success rates. The national average live birth rates for women under 38 years of age is 21% (ASRM/SART Report, 2000). For Reproductive Sciences Center's most recent frozen embryo success rates, see latest IVF success rates.

What are the disadvantages of embryo freezing?
This approach is limited by the time required to perform the IVF procedures. There may not be enough time for a complete IVF cycle before cancer treatment must be initiated. As with all advanced fertility treatment options, there is no guarantee that you will respond appropriately to the ovulation induction medications and produce a reasonable number of fertilized eggs and healthy embryos for freezing. In addition, ovulation induction may not be advised for certain cancer patients.

Who are potential candidates for egg freezing?
All women planning to undergo cancer therapy that can result in irreversible ovarian failure. In particular, women who do not have a partner and reject the use of donor sperm, or, do not wish to have embryos frozen for ethical or religious reasons. As with embryo freezing, egg freezing necessitates undergoing controlled ovarian hyperstimulation (to induce multiple follicular development), prior to chemo- or radiotherapy and is therefore not advised for certain medical conditions.

Are there potential risks associated with freezing eggs?
Yes, earlier concerns regarding possible detrimental effects of freezing on the genetic constitution of eggs have been largely alleviated as normal healthy babies have been born. Nevertheless, despite the major improvements with this approach, egg freezing should still be considered experimental as more data is needed to optimize the technique and determine potential risks to offspring.

Who are potential candidates for ovarian tissue cryopreservation?
Patients for whom lengthy hormonal stimulation and egg or embryo cryopreservation is unsuitable. In particular, children and very young women, patients undergoing bone marrow transplantation (where intensive therapy results in a very high rate of ovarian failure), and patients undergoing oophorectomy for endometriosis, breast cancer or benign ovarian tumors.

How successful is ovarian tissue cryopreservation?
Although still considered experimental, cryopreservation of tissue from the outer region (cortex) of the ovary, which contains numerous primordial follicles and immature eggs, has evolved into a promising development for fertility protection. To date, successful ovarian tissue cryopreservation and transplantation is limited to various animal species. At this time, no pregnancies have resulted from human cryopreserved ovarian tissue, although, there is a recent report of follicle growth after transplant of frozen-thawed ovarian tissue in a patient with benign ovarian disease. Research studies are being conducted to determine whether transplantation of cryopreserved ovarian tissue to the original site or a different site is preferable.

What are the safety concerns with ovarian transplantation?
The risk of reintroducing cancer cells depends on the disease type (high risk are leukemia and neuroblastoma, breast cancer carries a low to intermediate risk), activity, stage and mass of malignant cells transferred.At the time of ovarian removal, samples are taken and screened for the presence of cancer cells in the ovary. There is a need to develop improved screening methods that can detect minimal residual disease in ovarian tissue.

More information for cancer patients is also available at FerileHope.