Options for Women
Knowing that there are options for many women to protect or preserve their reproductive potential before cancer treatment begins can make it less challenging to discuss the possible reproductive side effects of treatment with your patients. There are two strategies that can be used: – (1) removing and freezing gametes (eggs) or (2) taking steps to reduce the reproductive impact of cancer treatment. For interested patients, consultation with a fertility specialist before treatment begins is highly recommended.
Cryopreservation of Gametes
Embryo Freezing:Embryo freezing involves the freezing and storing of embryos obtained by ovarian stimulation, egg retrieval, and in vitro fertilization. Embryo freezing is performed by a reproductive endocrinologist. Prior to embryo freezing, the patient undergoes a cycle of in vitro fertilization.
Egg Freezing:Egg freezing involves the freezing and storage of unfertilized eggs obtained by ovarian stimulation and egg retrieval. The procedure is performed by a reproductive endocrinologist. The patient undergoes a cycle similar to in vitro fertilization (IVF).
Ovarian Tissue Freezing:Ovarian tissue freezing is an experimental technique that involves the freezing and storage of tissue from the ovarian cortex. This tissue holds primordial follicles, each containing a single immature egg.
Minimizing Reproductive Damage
Ovarian TranspositionOvarian transposition refers to a surgical repositioning of the ovaries outside the pelvic radiation treatment (RT) field to reduce ovarian exposure. Ovarian transposition is generally performed using a minimally invasive surgical procedure.
Ovarian SuppressionOvarian suppression involves the use of GnRH agonists (e.g, leuprolide, goserelin) to suppress the recruitment of follicles to undergo maturation, to minimize blood flow to the ovaries, or to potentially directly protect eggs within the ovaries.
Fertility-Sparing SurgeriesFor appropriate cases of early-stage gynecologic cancers, certain conservative treatments to preserve fertility may be considered:
- Radical trachelectomy for cervical cancer
- Unilateral oophorectomy for ovarian cancer
- Progestin therapy for endometrial cancer