Choosing Female Fertility Preservation Before Starting Chemotherapy
Before starting chemotherapy, Thanaydi Sandoval met with her care team to discuss fertility preservation.
The day she turned 18, Thanaydi Sandoval learned she had Ewing sarcoma, a cancer of the soft tissue. She had recently started her freshman year of college.
As her doctor discussed a treatment plan with her, he asked Sandoval what seemed like a strange question: “Do you plan on having children someday?”
But the timing of the question was crucial. Sandoval was about to start chemotherapy. Some of the medicine could affect her ability to have children.
Some chemotherapy medicines can damage the ovaries, the glands that contain and release eggs a woman needs to become pregnant. Ovaries also make the hormones estrogen and progesterone. They help prepare a woman’s body for pregnancy. Some medicines can destroy or decrease the number of eggs or disrupt the way ovaries send hormone signals.
Sandoval’s doctor told her that she had an option that could preserve her fertility, the ability to conceive children.
Decision to freeze eggs
Sandoval chose to freeze her eggs before she started cancer treatment.
Sandoval liked the simple way her doctor brought up the subject of fertility preservation. For her, the answer was clear: Yes.
“In my mind, I knew I wanted to have a family,” Sandoval says. “So, my care team explained to me that I had this option of freezing my eggs before receiving treatment, and that would possibly be better than trying to have a family without doing that. It was in that moment when I thought it made sense. I wanted to preserve that ability and lower the risk of having any fertility issues.”
She chose to freeze her eggs (oocyte cryopreservation). The egg freezing process involves these steps:
- Hormone injections: Patients get hormone shots for about 2 weeks. These hormones help the ovaries develop more mature eggs than usual. The care team keeps track of progress with blood tests and ultrasounds.
- Egg retrieval: Once the eggs are ready to be harvested, a doctor uses a thin, hollow needle guided by ultrasound to help see the ovaries. The needle is inserted through the vaginal wall to remove fluid from follicles in the ovaries. This fluid contains the eggs. Patients are asleep or have medicine to help them relax during the process.
- Egg freezing: After the eggs are collected, they are frozen and stored safely in a lab. The eggs can stay frozen for years until the woman is ready to use them.
If Sandoval, now 28, decides she would like to use her eggs to become pregnant, she would go to a fertility clinic where her eggs would be sent. The eggs will be removed from storage, fertilized with sperm, and implanted into her uterus.
Egg freezing has a high success rate. But outcomes depend on factors like the number of eggs retrieved and the patient’s age.
The process was more difficult than Sandoval thought it would be. Sometimes, she asked her mother to give her the injections because she found it difficult to give herself shots. She remembers the hormone injections causing her to have extreme emotions.
And she experienced pain after the surgery to retrieve her eggs.
“It wasn’t an easy process,” Sandoval says. “I had to do a lot of things leading up to having my eggs removed.”
But it was all worth it to give her the chance to have children, she says.
Fertility preservation options
Fertility preservation options depend on the patient’s age, gender, and type of treatment, says Kari Bjornard, MD, director of the fertility clinic at St. Jude Children’s Research Hospital.
Female fertility preservation
As in Sandoval’s case, egg freezing is an option for female patients who are having menstrual cycles and have ovaries that are releasing eggs.
At some treatment centers, younger girls may have the option to freeze ovarian tissue.
Male fertility preservation
Males who have gone through puberty can undergo sperm banking. This process involves collecting and freezing sperm for future use.
Some treatment centers may offer younger boys the option of testicular tissue freezing, but it is considered experimental.
For patients having radiation treatments, the care team may shield the ovaries (females) and testicles (men) to protect them from radiation damage. In some cases, surgical procedures can help protect reproductive organs.
Factors to think about with fertility preservation
There are important facts to consider about fertility preservation.
- Fertility preservation may not be possible. In some cases, such as acute leukemias, patients may be too sick to delay treatment. Egg retrieval (women) and sperm banking (men) must happen before treatment starts. For egg retrieval, it takes about 10–14 days from the beginning of the process to the egg retrieval. Patients can usually start cancer treatment within a day or 2 after that. The sperm banking process can be done within 24 hours. Treatment can start right away afterward.
- Fertility preservation is a serious and personal choice. Decisions about fertility involve cultural and spiritual issues. Fertility preservation is an elective procedure. It is scheduled in advance and is not a medical emergency.
- Fertility preservation options can be expensive. Some fertility preservation procedures may not be covered by health insurance. They may be an out-of-pocket expense. Patients can ask their care team about financial assistance programs or grants for fertility preservation.
- There are other ways to build families. There are other options to have children such as adoption. Choices may be shaped by culture or spiritual beliefs. Talking with a counselor can help you understand options and find support.
Not all cancer treatments affect fertility
It is important to remember that not all treatments for cancer and other serious illnesses cause infertility, Bjornard says. So, people having treatment should use birth control if they plan to be sexually active and do not want to have children.
“We are careful to counsel patients about both fertility preservation and birth control,” Bjornard says. “Unplanned pregnancies during or right after treatment can lead to other health concerns for both the baby and mother."
Taking care of mental health
Fertility preservation and the decisions involved with it can be an emotional and difficult process, Bjornard says. In some cases, fertility preservation efforts are not successful.
It is normal to experience anxiety and depression. Teenage patients may feel awkward because they may go to adult fertility clinics for the fertility preservation process.
Psychologists, chaplains, and licensed clinical social workers can provide counseling and support.
When patients decide to start a family
Infertility is the inability of a couple to conceive a child after 1 year of regular, unprotected sexual intercourse. After that period, people may want to see a fertility specialist.
People who had treatment that can cause infertility may want to seek assistance sooner than a year, Bjornard says.
“Whether it's an OB/GYN or fertility specialist, patients should share their cancer history and whether they have any reproductive materials (sperm, eggs) stored somewhere,” Bjornard says. “That may speed up their ability to get testing and even move forward in the fertility process instead of waiting so long.”
Happy with her decision to freeze eggs
Sandoval speaks with her physician at her survivorship care clinic.
Sandoval is now a fifth-grade teacher in the Boston area. She does not have a partner now but looks forward to being a mother in the future. She feels grateful that she had the chance to have some of her eggs preserved in case she needs them.
Sandoval advises other cancer patients considering fertility preservation to ask many questions to make sure they understand what is involved in the decision.
“If I could talk to my younger self, I would tell myself to get as much information as you can, even though you are overwhelmed,” Sandoval says. “My second piece of advice is to lean on the people around you. Ask the people close to you to help ask questions or to take notes for you. I’m grateful that I had my mom with me. She was a great support.”
For now, Sandoval is focused on her career and is living her best life.
If you or your child has been recently diagnosed with cancer or another serious illness, talk to your care team before treatment starts about how it may affect fertility. Discuss fertility preservation options if needed.
If fertility preservation is not possible, you can explore other family-building options, such as adoption or using donor eggs or sperm. Planning for the future is a powerful way to take control during treatment.
