Fertility Preservation FAQ
(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.
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?
A woman is born with all the eggs she will ever have. Once her eggs ovulate or are destroyed, she cannot get them back. Chemotherapy damages or destroys eggs, which can prevent a full-term pregnancy or cause genetic abnormalities, among other concerns. A man is born with the ability to produce sperm into late adulthood. Chemotherapy also damages or destroys sperm. Although a man can regain the ability to produce more sperm after cancer treatment, it may take up to 5 to 10 years, and some men may never recover the ability to make sperm.
How does radiation therapy impact my fertility?
Radiation to the pelvis can damage eggs within the ovaries. High-dose radiation in the body can cause impaired blood flow to the ovaries and uterus, which makes carrying a pregnancy to term difficult. Similar to the risk to the ovary, pelvic radiation also damages sperm. Although a man can regain the ability to produce more sperm after cancer treatment, it may take up to 5 to 10 years, and some men may never recover the ability to make sperm. This risk of infertility is greater with radiation.
Will every woman be left in menopause from chemotherapy?
Not every woman will experience premature ovarian insufficiency or failure (menopause) from chemotherapy or radiation. An average of 50 percent of all women treated with chemotherapy for breast cancer will experience premature ovarian insufficiency but chemotherapy regimens for other cancers may pose very little risk of early menopause.
What raises my personal risk for infertility?
Certain factors like medical diagnosis, age at diagnosis, type and dose of chemotherapy, dose and location of radiation therapy, and bone marrow or stem cell transplant increase the risk for infertility.
What are my fertility preservation options?
There are several ways to preserve fertility before you begin treatment for cancer or other medical conditions requiring chemotherapy. Below is a table that briefly describes your options:
| Process Description | Success Rates | Standard/ Experimental | Cost | Option for: | |
|---|---|---|---|---|---|
Sperm Freezing |
A semen sample is provided for processing and freezing. The sample may be produced by ejaculation. Sperm can also be obtained through micro-surgical techniques under local anesthesia called TESE (testicular sperm extraction) or TESA (testicular sperm aspiration). Sperm is frozen for future intrauterine insemination (IUI) or in vitro fertilization (IVF). |
Success rates are *** |
Standard |
$550 including first year of storage. |
May be a good option for boys age 12 and older and all adult men. |
Embryo Freezing |
The ovaries are stimulated with medications to mature multiple eggs for retrieval. Embryos are created through in vitro fertilization (IVF) when the retrieved eggs are combined with sperm in a glass dish and frozen for later implantation. |
Success rates vary by age and center, up to 65% for women under age 35 years. |
Standard |
$10,000-$15,000 |
May be a good option for women age 27 and older. |
Egg Freezing |
The ovaries are stimulated with medications to mature multiple eggs for retrieval. Retrieved, unfertilized eggs are frozen. |
Success rates vary by age and center, now equivalent to embryo banking (up to 65% for women under age 35). |
Standard |
$10,000-$15,000 |
May be a good option for single women who do not wish to use donor sperm. |
Testicular Tissue Freezing |
A small portion of testicular tissue is removed from the testes. The tissue can be liquified to remove the sperm for freezing or the entire tissue can be frozen for future transplantation. |
There have been no human births yet from testicular tissue freezing as this is a newer procedure and is not widely available. |
Experimental |
Covered by research funds. |
May be a good option for boys 12 and older and all adult men who cannot produce an ejaculate. It is also the only option for pre-pubertal boys who have not yet begun to produce sperm. |
Ovarian Tissue Freezing |
Ovarian tissue is harvested (removed) from the body during an outpatient, minimally invasive surgical procedure. The ovarian tissue is frozen for future transplantation after fertility harming treatments. |
Not much published data about success as ovarian tissue cryopreservation (freezing) is a newer procedure and not widely available. |
Standard |
$5500-$25,000 |
May be a good option for women who don’t have time for ovarian stimulation before fertility harming therapies. May also be an option for women whose religion or diagnosis makes ovarian stimulation a non-viable option. It is the only option for pre-pubertal girls. |
How much do the fertility medications cost?
Fertility medications can cost between $3,000-5,000 for an egg or embryo banking cycle, and we understand that this is a substantial expense. The Fertility Preservation and Reproductive Late Effects program at the University of Colorado is fortunate to partner with a specialty pharmacy 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. In adolescents, an ultrasound is typically performed on the abdomen, rather than vaginally. 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 through the use of an aromatase inhibitor, such as Letrozole, to 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 cancer 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?
Yes. New random-start protocols allow stimulation to start on any day of the cycle. It is important to receive a consult with a member of the fertility preservation team as soon as you can. Patients with some cancers, such as sarcoma and breast cancer, can wait two to six weeks to begin their cancer treatment. However, many cancers such as leukemias require immediate therapy and some oncologists may recommend not to delay treatment based on your specific diagnosis. This discussion is a shared decision between the patient, oncologist, and fertility specialist.
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 a day or two. A transvaginal ultrasound is performed, and eggs are retrieved through a needle attached to the probe. 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 involves using a GnRH-a (Gonadotropin Releasing Hormone analog) injection to temporarily “shut down” the ovaries during chemotherapy in the hopes that the follicles will be protected from the chemo. The data is conflicting on whether ovarian suppression is beneficial for fertility preservation in all patients. The data most supportive of ovarian suppression to protect the ovaries is in patients with breast cancer. Many patients receive GnRHa to prevent menstrual cycles during chemotherapy, so if there is protection to the ovaries, these patients may benefit anyway.
I’ll be on Tamoxifen - how does that impact my fertility?
While Tamoxifen itself does not damage your reproductive function, most women are prescribed this medication for five years. It is 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 also has on your reproductive function.
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.
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 have biological children, it’s a good idea to consider preserving your fertility before fertility harming treatments.
What if I am infertile after cancer treatment?
Egg, embryo or sperm donation, surrogacy and adoption are all options if a woman or man is left infertile or when pregnancy poses a health risk to a woman.
What are the next steps I should take?
Speak to your physician about whether you should consider preserving your fertility before fertility harming therapies. Your physician can then refer you for consultation by a member of the fertility preservation and reproductive late effects team at the University of Colorado Comprehensive Cancer Center.
Can I talk to someone directly about this?
If you, your child or someone you love is facing a risk to fertility from treatment for a medical condition, please email the Fertility Preservation and Reproductive Late Effects program at the University of Colorado Comprehensive Cancer Center or Children’s Hospital Colorado at FertilityPreservation@CUAnschutz.edu.