When should I discuss fertility preservation with my doctor?
Treatment for ovarian cancer can limit your ability to have children in the future. After your diagnosis you may feel overwhelmed with information and choices concerning your diagnosis, treatment and next steps, but it is important to have the discussion about fertility before your treatment starts because your options will significantly decrease after your treatment starts. You may not have been thinking about having kids soon and your diagnosis may speed up a lot of those conversations and decisions. Bring along your partner or a friend to help understand the options for women at risk of infertility because of their cancer treatment.
How does my treatment impact my fertility?
Chemotherapy can damage healthy cells in your reproductive system. Certain treatments, such as a surgery, can put you at risk for infertility or premature menopause (See side effects: Menopause). If you think you might want to have children in the future, even if you have not decided yet, it is a good idea to discuss your options for fertility preservation with your health care team before chemotherapy or surgery. Fertility preservation takes place during certain phases of the menstrual cycle which is why consulting a doctor as soon as possible is suggested in order to have the best possible outcome when harvesting eggs.
How do cancer treatments impact my fertility?
Chemo: Certain chemotherapy drugs can cause acute ovarian failure which results in fewer follicles which can lead to infertility. Chemotherapy can damage healthy cells in your reproductive system. Certain drugs can put you at risk for premature menopause.
Surgery: Depending on your staging, you and your health care team may decide a salpingo-oophorectomy is the best course of action. This means the ovary and the fallopian tube are removed. You can have a bilateral (both fallopian tubes and ovaries are removed) or a unilateral (one fallopian tube and its corresponding ovary are removed) salpingo-oophorectomy, depending upon your stage of cancer. The removal of your ovaries can greatly impact your fertility.
How can fertility be preserved?
There are several options:
- Embryo cryopreservation: A procedure in which eggs are harvested, fertilized through IVF and then frozen. At the beginning of their menstrual cycle, patients will receive hormone injections in order to produce a large amount of eggs to be fertilized. Embryo cryopreservation requires a partner that can provide sperm. This procedure is often very costly and can run up to $12,500 per cycle plus fees to store the embryo.*
- Egg freezing: This procedure is similar to embryo cryopreservation, but eggs are frozen, which are larger and more delicate than embryos, making embryo cryopreservation more successful. If you do not have a male partner or donor but want to keep the option of children open, egg freezing could be an option for you. The procedure can run around $12,000 plus storage fees.*
- Ovarian shielding: Shields are placed near your pelvis in this procedure in order to block the pelvic area from any radiation that the body may be receiving.
- Ovarian transposition: If radiation is being administered to the pelvic region, this surgery may be used in which the ovaries are repositioned in a way that removes them from the designated path for radiation.
*These numbers represent estimates. The cost of fertility treatment and insurance coverage can vary. It is important to note that not all insurance plans will cover the cost of fertility treatments. Some options may be covered but it will be dependent on the procedure and your insurance coverage. Talk to your insurance company and make sure you fully understand your policy before going ahead with any fertility procedures. For additional help understanding your options, see the Resources section.
While uncommon, a diagnosis of ovarian cancer during pregnancy can happen and is devastating news for any mother-to-be. Approximately 0.1% of pregnant women are diagnosed with a cancer, ovarian cancer being one of the most common. Because of the sensitivity of the fetus, particularly early on in the pregnancy, it is important to discuss your treatment options with your gynecologic oncologist as well as your OB GYN. Including a social worker or therapist can help you and your family understand your needs and work through the options to make a decision best suited for you, your health and your family.