What is fertility preservation?
Fertility preservation is a process where a person can save their eggs or reproductive tissue. This will increase the likelihood that they can have biological children someday if they choose to. Download this fertility preservation handout.
What is fertility?
Fertility is the ability of a person to become pregnant and carry a fetus.
When a baby is born, their ovaries contain all the eggs they will ever have, typically over a million. Over time, the number of eggs naturally decreases. Usually around the age of 50, only a small number of eggs remain. If eggs are lost earlier than that, it can lead to premature ovarian insufficiency, when the ovaries stop working.
What are ovaries?
Ovaries are two oval shaped organs located on either side of the uterus. They contain all the eggs a person will ever have. They also make hormones, such as estrogen and progesterone.
How cancer/bone marrow transplant affects fertility?
Some treatments can speed up how fast the number of eggs decreases. This can cause the ovaries to stop working. Due to the early loss of eggs, the amount of time a person has for having children may be shortened or absent. Therefore, it is important to think about ways to preserve fertility before starting treatment.
Which therapies impact fertility?
Your doctor will tell you if there are potential risks to fertility from the treatment you are receiving. In general, fertility may be affected by:
- chemotherapy: certain types of chemotherapy, such as alkylators (e.g., cyclophosphamide, ifosfamide)
- surgery: removal of reproductive organs (e.g., ovaries, uterus, cervix and vagina)
- radiation therapy:
- close to or on the ovaries and/or uterus
- on the head (cranial)
When should fertility preservation happen?
Fertility preservation is time-sensitive. It should be done before treatment starts if possible. There may be certain times when it cannot be done prior to starting treatment, and your health-care team will discuss fertility preservation options with you.
What if treatment has already started or finished?
There may still be options for fertility preservation after treatment starts, depending on the type of treatment.
Is it still possible to have a family and children in the future if fertility preservation does not happen?
There are many ways to have a family and children in the future. Some people will maintain the option to have biological children despite having no fertility preservation procedures. However. If having biological children is not possible or wanted, other ways to have children:
- adoption
- fostering
- surrogacy
- egg donation
Some people may also choose not to have children.
Options for preserving fertility
Ovarian tissue cryopreservation
- Available for people of any age, including young children.
- A surgical procedure (laparoscopy) is done to remove one ovary
- The tissue is frozen and stored.
- If the person wants to become pregnant in the future, the ovarian tissue can be thawed and transplanted back into the body.
Egg (oocyte) freezing
- Can only be done in patients that have gone through puberty
- Hormone injections are given for 10 to 14 days to help the ovaries produce many large follicles that contain mature eggs. During this time, blood work and ultrasound tests are done to monitor the response to the injectable medications.
- The eggs are collected during an outpatient procedure. This is done under light sedation using a transvaginal (through the vagina) ultrasound-guided approach.
- The eggs are then frozen for future fertility treatments.
Ovarian tissue cryopreservation is generally done as a day procedure (no need to stay overnight in the hospital). Some patients may need to be admitted the night before the procedure, and your health-care team will let you know if this is required. Your health-care team will give you personalized guidance for care after the procedure.
Risks associated with fertility preservation
Overall, both procedures are low-risk and are well-tolerated.
Risks of egg freezing
- Side effects from hormone injections: Bloating and abdominal discomfort (feeling “puffy” or crampy), headaches and mood swings, bruising or soreness where the injections go.
- Risks associated with anesthesia
- Bleeding
- Infection
- Rare injury to nearby organs like the bladder or bowel
Risks of ovarian tissue cryopreservation
- Pain at surgical sites of laparoscopic oophorectomy (ovary removal)
- Risks associated with anesthesia
- Incision redness / irritation
- Bleeding
- Infection
- Rare injury to nearby organs like the bladder or bowel
Frequently asked questions
Does fertility preservation cost money?
Some procedures may have costs. However, resources are available that can help cover these costs. Ask your health-care team for more information.
Do young people need permission from a parent/guardian to talk about fertility preservation or to go through the procedure?
Patients are encouraged to talk to their parents or guardians about fertility preservation. However, the choice to meet with a fertility specialist or to go through the procedure is up to the patient. To go through the procedure patients need to understand the benefits, risks and impact in order to give consent.
What do most patients/families choose?
There is no right or wrong choice, and fertility preservation may not be right for everyone. Each situation is different and your health-care team will support your choice.