Fertility preservation

With a cancer diagnosis often comes questions about whether a person will still be able to build a family after cancer treatment. Here we explore fertility preservation options. 

[MUSIC PLAYING] If you're seeing me for the very first time, it means that you've just had a new diagnosis handed to you, and you're probably learning and dealing with this new diagnosis. Your health care team has probably mentioned the option of fertility preservation in the event that you survive your treatment and the cancer is in remission or gone. When patients survive their cancer, one of their main concerns is, can they build a family? And you have that option right now to decide if you would like to preserve your eggs or your embryos, depending on your situation, for your future use. In many ways, it's like an insurance policy. You're going to make an attempt to preserve some hope in the future that you can have your own biological children.

The first thing that we do is to get an assessment of ovarian reserve. And we do that with a blood test and an ultrasound. The ultrasound will show us how many follicles there are on the ovary, and the blood tests will correlate that ultrasound finding. If the level is extremely low, it's unlikely that we'll be getting enough eggs or embryos to work with, and a different alternative might be chosen.

If you have enough eggs, then you would be able to proceed with the chosen treatment, and we would initiate stimulation with medications that cause the ovaries to make follicles. We watch those follicles grow, and when they're ready, we use one final shot. 36 hours later, we go into the ovaries, into the follicles, and we take the eggs out.

The actual egg retrieval process is done with a vaginal ultrasound and a needle guide. So we use a monitor, and we can see that the needle is going into each follicle. We use suction to take the fluid out of that follicle into a test tube, and then we go into the next follicle and aspirate the fluid out of that follicle and so on until all the follicles are empty and all the eggs are in the lab.

The lab searches under a microscope to find the eggs in the follicular fluid that we sent to them. Because they're so small, they're microscopic, you can only see them under the microscope. And then once they find the eggs, they prepare them for freezing. It's an elaborate process in the lab to freeze the egg. The egg is the largest cell in the body, and so it has a large water content to it. And the freezing process is called a fast freeze or vitrification. And we utilize the fast freeze in order to remove as much water as we can from the egg before we freeze it. And then hopefully, we get better post-thaw survivabilities and fertilization rates and success rates.

Some patients are afraid that the procedure might hurt, but actually it's much easier than it's ever been in the past. In the past, the needles used to be big, and now they're small. All the needles are subcutaneous. And they can be combined. So for this purpose, you can actually do IVF with about 15 small shots total and then have the eggs taken out under IV sedation, so that part doesn't hurt at all.

We know that the age of the egg donor is very important as far as quality and quantity of the egg. And the more eggs that can be banked, the better chance for success. For frozen eggs, we thaw the eggs, we fertilized them with the male sperm, and we document fertilization. We watch the embryos grow for five days. And on the fifth day, we transfer hopefully one embryo into the uterus and can freeze the remaining embryos for the future use. Because the cancer patient has unique needs, we have a system in place where they call and can be seen the same day if not the next day.

Some breast cancers have a genetic etiology. The one that I'm thinking of is the BRCA gene, the BRCA1 and 2, or the BRCA mutation. And that little mutation on the gene is measurable, and there's a marker for it. So when patients who have the BRCA, they know that they have the BRCA mutation, come through IVF for fertility preservation, we can test the embryo and find out if the embryo has the BRCA mutation or not. And then in the future, we can choose to transfer only the healthy embryos. It's called preimplantation genetic diagnosis. And that's the way that we find out if the embryos are healthy or not.

And when the results come back, some of the situations could be that all the embryos are affected and that you have no embryos to transfer. That's a possibility. Sometimes, it comes back that embryos two, four, and six are healthy, and embryos one, three, and five are unhealthy, and then we know which embryos to transfer, and that's the perfect situation.

1,000 consecutive technical steps have to occur in order to properly get the eggs out, the embryos, fertilized, frozen, thawed, implanted to carry out a successful pregnancy. All fertility preservation is, is an insurance plan offering hope, but it's not a guarantee or a promise of success. We really want patients to look back without any regrets and know that they at least tried to push the odds in their favor.

One hardship for choosing egg or embryo cryopreservation is the cost. The cost of IVF is high. And it's often not covered by insurance. There are programs that you can apply to that help pay for the medications. And there's also medical credit cards for medical expenses where people can finance their cycles through.

It's always wonderful to be on the front lines of medicine and try to figure out what's right for every patient, but this technology isn't always right for everybody for whatever reason. All we do is help them try it on and see if it fits and then teach the patients about alternatives.

It might be too expensive. It might be too invasive. It might be too late. There may be lots of reasons why it's not a match. It doesn't mean that they're actually going to go forward, but they're going to come and hear and learn about it and decide if it's right for them.

Cancer treatment could affect your fertility. However, there are ways to preserve your fertility if you want to have the option to have children in the future. Now is the time to talk with your health care provider about your options.

What are some choices and how much may they cost?

In vitro fertilization (known as IVF) is the most common assisted reproductive technology. Your eggs can be preserved in two different ways for use after cancer treatment. They are:

  • embryo freezing (cryopreservation)
    • The cost to have IVF and freeze embryos is about $13,000 to $15,000.
    • The cost to store your embryos is free for the first year and then about $275 every 6 months.
    • The best candidates for embryo freezing are married women, single women with a committed male partner or women who choose to freeze embryos using donor sperm. The male partner will need sexually transmitted disease (STD) testing and a semen analysis.
    • This method has the highest chance of success for women.
  • egg freezing (oocyte cryopreservation)
    • The cost to have IVF and freeze eggs is about $10,000.
    • The cost to store your eggs is free for the first year and then about $350 every 6 months.
    • The best candidates for egg freezing are single women.

The cost to thaw and use your eggs or embryos is about $7,000.

Does insurance cover IVF?

IVF is often not covered by insurance. Some insurance companies cover the diagnostic (problem solving) testing, but not the treatment itself.

You may qualify for loans through medical financing companies. It is recommended that you check with your insurance company about what is and isn't covered under your plan.

How is IVF done? 

The IVF cycle begins by taking injectable medicines for about 2 to 3 weeks. These medicines are used to stimulate your ovaries to produce multiple eggs

The eggs mature in follicles in your ovaries. Ultrasound monitoring is used to follow the growth of these follicles. When the eggs are ready, the doctor uses transvaginal ultrasound to guide a needle through your vagina into the follicles in your ovaries. The doctor retrieves the eggs and fluid from the follicles through the needle.

After your eggs are removed, there are two ways to preserve them.

  • Embryo freezing. Your eggs are fertilized in the lab, frozen and stored as embryos.
  • Egg freezing. Your unfertilized eggs are frozen that same day. This method requires the same amount of time as embryo freezing.

How long does IVF take?

Depending on where you are in your menstrual cycle or if you are already on birth control pills, your eggs can be removed in 2 to 3 weeks.

Are fertility medicines safe to take while you have cancer?

Some cancers are hormone-sensitive. This means that estrogen and progesterone could cause the growth of some cancers such as breast cancer.

Fertility medicines are similar to your menstrual cycle hormones but just at different levels. During IVF, the goal is to keep your estradiol (hormone) level low. The medicines used to do this are similar to the medicine used to treat breast cancer (such as tamoxifen or aromatase inhibitors).

Estrogen levels are only elevated (raised) for a short period of time during IVF. If having high levels of estrogen is not good for you, it is possible that getting pregnant may not be recommended because it is 9 month of high hormone levels.

Having a hormone-sensitive cancer doesn’t mean that fertility preservation is not an option. Most research suggests that women who have breast cancer can safely get pregnant after breast cancer treatment.

Your oncologist will refer you to see a fertility doctor if he or she feels that fertility preservation is safe for you and you are medically ready to have fertility treatments.

What is the chance for success?

The success of IVF depends on your age and how many eggs you have.

The best case scenario is a promise for the possibility of getting pregnant. There are many steps that have to go perfectly in order to harvest, fertilize, freeze, thaw and hope for implantation to happen. It is possible that you
won’t get pregnant.

Success rates

  • The pregnancy rate for frozen embryo is about 40 to 50 percent. This rate is for a patient younger than age 35 with normal ovarian reserve.
  • Embryo freezing has a higher success rate than egg freezing.
    • Egg freezing is relatively new and may provide false reassurance.
    • The egg survival rate after being thawed and the fertilization rates are improving each year.

Is IVF right for me?

Deciding if IVF is right for you will depend on factors such as:

  • your cancer stage
  • length of your treatment
  • personal choice

It may be helpful to talk with a nurse practitioner if you have additional questions before your proceed with treatment.

To schedule an appointment or to speak with a nurse practitioner, please call 612-863-5390.

You may also want to talk with your health care provider about medicines that may protect your ovaries during some types of chemotherapy. They may increase the chance of fertility after your treatment.

Source: Allina Health's Patient Education Department, Fertility Preservation, can-ah-16347
Reviewed By: Allina Health's Patient Education Department, including experts from Virginia Piper Cancer Institute, Minnesota Oncology, Center for Reproductive Medicine
First Published: 11/15/2014
Last Reviewed: 11/15/2014