University of Colorado Oncofertility & Fertility PreservationFertility Preservation

Frequently Asked Questions

What is Fertility Preservation?

Fertility preservation is a term used to describe procedures that help protect an individual’s future reproductive opportunities. While some may pursue fertility preservation as part of their medical treatment plan for conditions such as cancer, autoimmune disease and organ transplant, others elect to preserve their fertility for personal reasons. Many different fertility preservation options are available. Continue reading to learn more.

Why choose Fertility Preservation?

Many women, men and children find that taking action to protect the future they envision as parents is an uplifting and empowering experience during a very difficult time.

How does chemotherapy impact my fertility?

Chemotherapy damages or destroys your eggs. A woman is born with all the eggs she will ever have. Once her eggs ovulate or are destroyed, she cannot get them back. Damage to the remaining eggs can prevent full-term pregnancy or genetic abnormalities, among other things.

How does radiation therapy impact my fertility?

Radiation can also damage eggs within the ovary. Patients who receive high-dose radiation can also have impaired blood flow to the ovaries and uterus, which makes carrying a pregnancy to term difficult.

Will every woman be left in menopause from chemotherapy?

Not every woman will experience premature ovarian failure (menopause) from chemotherapy. An average of 50 percent of all women treated with chemotherapy for breast cancer will experience premature ovarian failure, but other chemotherapy poses very little risk to fertility. Many women are capable of having children after treatment.

What raises my personal risk for infertility?

Certain factors like medical diagnosis, age at diagnosis, type of chemotherapy and dosage of chemotherapy, dose of radiation therapy, and bone marrow transplant raises the risk for infertility.

What are my fertility preservation options?

There are several ways to preserve fertility before you begin cancer treatment. The most common approaches require stimulating the ovaries with drugs to mature multiple eggs. Below is a table that briefly describes your options:

Embryo Freezing Egg Freezing Ovarian Tissue Freezing
Created through in vitro fertilization when the harvested eggs are combined with sperm in a glass dish and frozen for later implantation Harvesting and freezing unfertilized eggs Freezing of ovarian tissue and re-implanting after cancer
Success rates vary by age and center, up to 40% Success rates vary by age and center, now equivalent to embryo banking (up to 40%) Not much published data about success as it’s a newer procedure and not widely available
Standard Standard Experimental
$10,000-$15,000 $10,000-$15,000 $12,000-$20,000
May be a good option for women age 27 and older May be a good option for single women who do not want to use donor sperm May be a good option for women whose religion or diagnosis makes ovarian stimulation improbable

 

How much do the fertility medications cost?

Fertility medications can cost anywhere from $3,000-5,000 for an egg or embryo banking cycle, and we understand that this is a substantial expense. The Oncofertility Program at University of Colorado Advanced Reproductive Medicine is fortunate to partner with a specialty pharmacy in order to provide the majority of your medications at no expense.

What’s involved in stimulating my ovaries?

Standard stimulation requires a 10-12 day period of time where you self-administer hormone injections into your abdomen. Your doctor will draw blood and perform a vaginal ultrasound every other day to monitor your progress. Two days before your egg retrieval procedure, you will use a trigger injection to signal the last step in the development of eggs before release. Just before ovulation would happen, your fertility specialist will perform the egg retrieval procedure.

I have a hormone-sensitive breast cancer. Can I still do standard stimulation?

Many women with hormone-sensitive breast cancers have successfully completed fertility preservation with standard stimulation, though the use of an aromatase inhibitor, such as Letrozole, can keep estrogen levels lower than standard ovarian stimulation. This is a personal decision and should be discussed with both your oncologist and fertility specialist. Some fertility specialists do not use standard stimulation any longer since there is another, safer alternative available. Some factors to consider may be diagnostic stage, timing of treatment and prognosis.

How many eggs will I retrieve?

Each woman’s body is very different. Some women already have low ovarian reserve to begin with and therefore may retrieve fewer eggs. Many women in their twenties will retrieve over 20 healthy eggs. Typically, the older a woman is, the fewer eggs she will retrieve and the lower the egg quality. Your reproductive endocrinologist (fertility specialist) can help you with realistic expectations for your body.

Can I start the injections at any time?

No. You must start the stimulation on day one or two of your period. This often complicates a cancer patient’s timing with treatment. It’s imperative to receive a consult with a fertility doctor as soon as you can. Most patients can wait four to six weeks to begin their cancer treatment. Some oncologists will not want to delay treatment based on your specific diagnosis.

What is egg retrieval like?

Egg retrieval is a minor surgical procedure that takes about 20 minutes to complete and is done on an outpatient basis. You will receive light anesthesia and will be unable to work for just a day or two. There is typically not much pain or discomfort associated with the procedure, and minor cramping is normal.

Can I do anything during chemotherapy to protect my ovaries?

Ovarian Suppression is an option, though the data is conflicting on whether it is beneficial for fertility preservation. Using a GnRH-a (Gonadotropin Releasing Hormone analog) injection, the ovaries are temporarily shut down during chemotherapy in the hopes that the follicles will be protected from the chemo.

I’ll be on Tamoxifen, how does that impact my fertility?

While Tamoxifen itself does not damage your reproductive health, most women are prescribed this medication for five years. Its possible to get pregnant while taking Tamoxifen, but it’s not safe for a fetus. Depending on your age when you start Tamoxifen, it could mean that at the end of five years, you are significantly less fertile simply because of the natural aging process. This does not take into consideration the potential impact chemotherapy has on your reproductive health.

I’m 31-years-old, single and BRCA+. Should I preserve my fertility?

The BRCA genetic mutation leaves women at higher risk for breast and ovarian cancer. Doctors recommend patients who are BRCA+ have their ovaries removed between the ages of 35 and 40. Fertility declines with age, particularly after the age of 35 years. The older a woman is, the lower her ovarian reserve or number of eggs in the ovaries. Fertility preservation is a good option for those who are carriers of the breast cancer genetic mutation. Younger women will likely have more eggs available for banking, and they will likely be healthier. Women who are carriers of the BRCA gene also can use pre-implantation genetic diagnosis (PGD) of embryos to avoid transferring embryos that also carry the BRCA gene.

What raises my personal risk for infertility?

Certain factors like medical diagnosis, age at diagnosis, type of chemotherapy and dosage of chemotherapy, dose of radiation therapy, and bone marrow transplant raises the risk for infertility.

My doctor thinks my period will come back after chemotherapy. Should I still preserve my fertility?

While your period returning is a positive sign that your uterine lining responds to hormones that control your menstruation, it is not an indicator of ovarian reserve (the number of eggs you have left) or the quality of the eggs. If you are certain you want to be a mother, it’s a good idea to consider preserving your fertility.

What if I am infertile after cancer treatment?

Egg or embryo donation, surrogacy and adoption are all options if a woman is left infertile or when pregnancy poses a health risk.

Can I talk to someone directly about all this?

Please call 303-724-3378 to speak to a member of the Oncofertility team.

What are the next steps I should take?

  • Schedule a consultation with our reproductive endocrinologist to assess how fertile you are right now
  • Consult with your oncologist about the timing of your treatment