By Cathryn Smeyers
A recent article in the December issue American Journal of Obstetrics and Gynecology, entitled “Fertility preservation in women of reproductive age with cancer” provides a comprehensive overview of the current options for fertility preservation in women with cancer. The authors identified six different options for fertility preservation, clearly outlining the benefits and drawbacks of each.
Embryo Banking
The most tried and true method of fertility preservation for women, embryo banking is like an in vitro fertilization cycle (IVF) cycle done for patients with infertility, except that the embryos are not immediately transferred into the patient. Instead, after the oocytes are fertilized, the embryos are frozen and stored for the patient’s future use.
- Advantages:
- Established technique with predictable success rates
- IVF protocol can be altered to fit patient needs
- Disadvantages:
- Requires the male gamete and time for ovarian stimulation
- Potential for ethical issues with regard to handling of unused embryos
Oocyte Banking
Oocyte banking has come a long way in recent years. Like embryo banking, the patient undergoes ovarian stimulation to promote the growth of multiple oocytes. Unlike embryo banking, these oocytes are not fertilized before being frozen.
- Advantages:
- Provides greater reproductive flexibility (no male gamete needed)
- Success rates are improving
- Disadvantages:
- Requires time for ovarian stimulation
- Track record not yet as strong as embryo banking
Ovarian tissue cryopreservation
Ovarian tissue cryopreservation involves the banking of ovarian tissue that can later be transplanted back into the patient to restore or improve her fertility.
- Advantages:
- Avoids ovarian stimulation
- Option for pre-pubertal girls
- Possibility of pregnancy without future ART
- Disadvantages:
- Experimental procedure with unproven success rates
- Risk of reintroducing cancer in patient’s body
In vitro maturation of oocytes
In vitro maturation of oocytes involves removing immature oocytes from ovarian tissue, maturing them in vitro, and then using ART.
- Advantages:
- Provides greater reproductive flexibility
- Avoids ovarian stimulation
- Disadvantages:
- Results in fewer viable oocytes in comparison to embryo/oocyte banking, but procedure requires a similar amount of time
Gonadal suppression with GnRH agonists
Gonadal suppression with GnRH agonists involves protecting the ovaries from the affects of cancer therapy by using hormones to suppress ovarian function at the time of treatment.
- Advantages:
- No surgery required
- Preserves hormonal function and fertility
- Disadvantages:
- Uncertain efficacy
- Mixed results from trials
Ovarian transposition
Ovarian transposition is a technique in which the ovaries are protected from radiation by being surgically moved from the pelvis to another area of the body.
- Advantages:
- Decreases the risk of ovarian failure from irradiation
- Disadvantages
- Useful only to patients who must undergo pelvic radiation
- Surgical procedure required
- Patient may require IVF/ART if fallopian tube is cut during procedure
To learn more about fertility preservation options before, during, and after cancer treatment, including which chemotherapy regimes are most likely to affect fertility, please visit SaveMyFertility.org.