Fertility preservation

We know it can be hard to think about starting or growing a family when first diagnosed with cancer. But with the improvements in treatment, survival chances are high and the joy of having a baby after remission is possible. Not everyone has problems conceiving after cancer treatment, but we can’t predict who will or won’t have difficulty.

Women, men, and couples often freeze their eggs, sperm, or embryos so that they can attempt pregnancy at a later time. Cancer treatments and other medical procedures involving chemotherapy or radiation can affect a woman’s ability to have a baby (egg number and quality) and cause damage to sperm production in men. For men or women facing cancer treatment or other procedures that put fertility at risk, we recommended the patient freeze their sperm or eggs.

Cryopreservation

The process to collect and store reproductive materials is called cryopreservation, which involves freezing eggs, sperm or embryos and storing them at sub-zero temperatures. The quality of the genetic material is essentially frozen in time. When the woman or couple is ready, the material is thawed and pregnancy can be attempted through assisted reproduction.

Getting pregnant after treatment

Cancer treatments can lead to infertility, or the inability for men or women to have children. If you didn’t freeze eggs or sperm prior to cancer treatment, getting pregnant may be possible, but many times it cannot be done through intercourse and requires assistance from a doctor.

In vitro fertilization (IVF)

When you are ready to conceive the eggs or sperm can be thawed and the IVF procedure used to create embryos. The embryos can be used in a woman’s uterus even if she has gone through menopause. Extra embryos can be frozen for later use.

Costs

There are costs for freezing and storage of eggs and sperm. Our staff will be happy to discuss costs and determine if you have insurance coverage. Programs such as Livestrong may be able to assist with costs.

Procedure information for women and men

Women

Women are born with all the eggs they will ever have, and over time they deplete. Collecting a woman’s eggs requires about two weeks to stimulate the ovaries, then a minor surgical procedure to remove them.

• As women age, egg quality declines and the chance of losing a baby (miscarriage) goes up.
• Removing eggs and preserving them keeps the quality of the egg at that very time.
• When the woman is ready to conceive, the eggs can be thawed and injected with sperm to create embryos. These embryos can be placed back into her uterus, allowing her to have a baby with her own egg, later — even if she has gone through menopause. Extra embryos can be re-frozen for later use.

Procedure

Women may need to delay cancer treatment by about two or three weeks in order to collect eggs. Most women require about 10 days of stimulation with hormones to increase egg production (and the chance of pregnancy success later) before eggs are removed. This may be an important step, as we cannot predict how a woman’s ovaries—needed to create an embryo—will function after treatment. If the ovaries are no longer functioning after treatment then without prior freezing of her eggs a woman’s only chance for pregnancy would be through donor eggs (not her genetic material).

If her uterus is no longer functional, the embryos can be placed into a surrogate. If the woman has a partner or spouse, the eggs can be combined with the sperm and made into embryos in a lab before freezing.

Ovarian tissue preservation

We prefer to freeze eggs (oocytes) for cancer patients, but if a woman cannot delay chemotherapy prior to cryopreservation of the eggs, we may consider preserving ovarian tissue. This requires a surgical procedure to remove slices of the ovarian surface that contain the eggs. Once cancer treatment is complete, these slices can be thawed and replaced in the woman to help with hormonal production as well as potential for future pregnancy. While ovarian tissue cryopreservation has produced pregnancies, it is still considered experimental.

If you are interested in cryopreservation you will need to make an appointment ASAP with one of the doctors at VCU Health Reproductive Medicine and Endocrinology by calling (804) 327- 8820. No referral needed.

Men

Chemotherapy or radiation can knock out or reduce sperm production. Though production may recover, due to the effects of cancer treatment the sperm may have a higher amount of genetic damage that could lead to increased miscarriages (failed pregnancy) or birth defects. Sperm cryopreservation can be done in less than a week prior to receiving medical treatment.

• Most sperm samples are collected through masturbation, which can be done in a private collection room at our clinic or at home if you can get the sample to our of ce within one hour.
• Some couples prefer to collect semen at home, during intercourse. Collection condoms are available for use, but may decrease the volume of the sample.

A man may need one or two collections for storage. Each collection is split into vials, each containing about 5 million sperm. We recommend having at least 10 vials. Depending on the quality of the collection, it may take more than one time. There is a fee for the freezing process and an annual storage fee.

Men who are interested in cryopreservation of sperm may have your physician fax an order for “Semen Cryopreservation” to VCU Health Reproductive Medicine and Endocrinology at (804) 237-6637. Or, if you do not have an order, you can brie y meet with one of our physicians for counselling. Prior to chemo or radiation, call our of ce at (804) 327-8820 for an appointment for “sperm freezing.” Consent forms and a storage agreement must be signed at collection. If you are under 18 years old a parent must sign the consent as well.

Reproductive Medicine and Endocrinology
Stony Point Campus, Stony Point 9109
9109 Stony Point Drive, Third Floor
Richmond, Virginia, 23235
(804) 327-8820 Physician fax: (804) 237-6637