Cancer in young women of reproductive age is rare but occurs more frequently than many realize. While survival rates have improved significantly, this progress can be bittersweet. The treatments that effectively combat malignancy, such as chemotherapy and radiation, often lead to the complete loss of ovarian function. As a result, many young women who survive cancer may face infertility, with their only option for conception being the use of donated eggs. In recent years, however, advancements in medical care have aimed to preserve ovarian function during and after treatment. While no method has yet proven universally successful, ongoing research and new technologies are steadily showing promise in protecting fertility for cancer survivors.
Dr. Norbert Gleicher on CHR's fertility preservation programs.
It is important to recognize that all current fertility preservation treatments should still be considered experimental. However, in situations where the alternative is permanent sterility, using these methods can be a reasonable option — as long as patients fully understand their experimental status and acknowledge that none can guarantee future fertility. At CHR, we offer all of the fertility preservation methods described below, but we require patients to sign an "experimental" informed consent to confirm their understanding and acceptance of these treatments' experimental nature.
What unifies all of the currently available treatments is the need for quick and proactive treatment once the initial cancer diagnosis has been made. Since most cancer specialists urge rapid therapeutic responses, the time to act is usually very limited. Affected patients are, therefore, well advised to consult fertility experts who can react quickly. Close cooperation and coordination between fertility and cancer experts is of absolutely crucial importance.
Mostly based on the work of an Israeli group, we know that the devastating effects of, at least some, chemotherapeutic agents can be partially mitigated by pre-treating affected women with a hormone, called gonadotropin releasing agonist (GnRH-a). This medication puts the ovaries into a “rest” stage and, in doing so, can diminish the toxic effects of the chemotherapy on the eggs within the ovary. However, this medication is effective only when used alongside specific chemotherapy treatments.
Recently, egg freezing has received considerable attention, with some fertility centers and commercial enterprises heavily promoting it. At CHR, we’ve offered egg freezing as a clinical service for quite some time, but we emphasize that it is still considered an experimental procedure. Patients undergo the process with the proper informed consent, understanding that while it's a promising option, it’s not yet fully developed.
Even though techniques have improved, egg freezing still isn’t as reliable as embryo freezing. A single egg freezes and thaws less predictably than an embryo, making it harder to estimate future success rates. When we freeze embryos, we have a good idea of the chances of pregnancy after thawing and transfer. However, we can’t yet offer the same level of confidence with eggs, which limits how much guidance we can provide. It’s also important to note that freezing eggs requires a full IVF cycle, which may delay cancer treatment by at least a month, and a single cycle may only result in a small number of eggs, offering limited future pregnancy chances.
Re-implanting ovarian tissue is one of the most experimental fertility preservation treatments, with only two reported pregnancies worldwide. The process involves removing an ovary before cancer treatment, slicing the portion containing follicles, and freezing it. After cancer treatment, if the remaining ovary hasn’t regained function, these frozen slices can be re-implanted. The best results have come from re-implanting the tissue into the original ovarian capsule. While promising, this method is still highly experimental, with success rates undefined and concerns about the potential risk of reintroducing cancer through the re-implanted tissue.
At CHR, we emphasize the importance of transparency when discussing these treatments, as highlighted by the American Society for Reproductive Medicine. While fertility preservation options are showing promise, they are not perfect, and expectations should be managed carefully. We stress that if none of these methods work, egg donation is always available, which has helped many families grow. For many, the joy of parenthood far outweighs concerns about the egg's origin. In such cases, by the time most patients give birth, they usually have forgotten where the egg came from that produced their baby!
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