Understand the effects of cancer treatment and prevention on fertility and family planning, how pregnancy impacts hereditary cancer risk and options for assisted reproduction.

Assisted reproductive technology

Women with cancer face the possibility of infertility due to surgery, radiation, and chemotherapy. High risk women face certain infertility following surgery to remove their ovaries and tubes. Assisted Reproductive Technology (ART) is a multistep process which provides infertile women with the option to conceive biologic children in the future, even if they undergo menopause because of chemotherapy or surgery. The overall process can take anywhere from 2 to 3 weeks from start to finish. This is an option for women who are able to defer starting their cancer treatment for at least 2 weeks in order to allow time to create eggs and/or embryos which can be frozen and used later in life. Freezing eggs and embryos is the most effective way for women to preserve their fertility.

Here are the steps involved in ART:


Ovulation induction steps

  • Patients take hormone injections for 8-12 days to stimulate the follicles in the ovaries to grow.
  • The ovarian response is monitored frequently (using bloodwork and ultrasound) so that medication dosage can be adjusted if needed.
  • When a sufficient number of the woman's follicles are mature (reach 18mm in size), she undergoes a minor procedure under light sedation in which a fertility specialist extracts her eggs using ultrasound as a guide. It is an outpatient and minimally invasive procedure that takes less than 15 minutes.

 

Egg fertilization and embryo transfer

Once the eggs are harvested from the woman’s body they can be frozen in a process called egg freezing for later fertilization, or they can be immediately fertilized with sperm in order to form embryos. The embryos are grown in the laboratory for up to six days before being transferred to a woman’s womb. Alternatively, if a woman is not ready to become pregnant, the embryos can be frozen for later implantation. The embryo transfer procedure usually does not involve sedation and takes only a few minutes.


Egg freezing and embryo freezing

In a process known as cryopreservation, a woman’s unfertilized eggs can be harvested, frozen, and placed in long-term storage. Unlike embryo freezing, egg freezing does not require sperm for fertilization. As such, this is an ideal option for single women, or those who want to reserve the option to one day have children with a different partner. 

The egg-freezing process includes these steps:

  • Patients take hormone injections for 8-12 days to stimulate the follicles in the ovaries to grow.
  • The ovarian response is monitored frequently (using bloodwork and ultrasound) so that medication dosage can be adjusted if needed. 
  • For the egg retrieval, the woman is sedated so that a fertility specialist can extract her eggs using ultrasound as a guide. It is an outpatient and minimally invasive procedure that takes less than 15 minutes. The eggs are frozen the same day. 

Embryo Freezing

The embryo-freezing process is similar to the egg-freezing process. After retrieval, eggs are fertilized with sperm to create embryos that are frozen for future implantation. When the woman wishes to become pregnant, the embryo can be thawed, and transferred into the uterus. This procedure usually does not involve sedation and takes only a few minutes.


Implantation and pregnancy

Women who have removed their ovaries but still have a healthy uterus may be implanted and can carry embryos to term. In order to do so, they need to receive hormones to help sustain the embryo in the early weeks of pregnancy.  

Women who have had a hysterectomy or for whom pregnancy is not considered safe will need a gestational surrogate - a woman agrees to carry the baby to term. 


Concerns for newly-diagnosed women

Some women with cancer have concerns that delaying or interrupting cancer treatment to freeze eggs or embryos could increase the risk of cancer recurrence or metastasis. Most women can start an egg or embryo freezing cycle at any point in the menstrual cycle, limiting treatment delays by a little more than two weeks from referral to chemotherapy.


Concerns for women at high risk for cancer

Women who are at high risk for cancer who are considering Assisted Reproductive Technology may be concernd that fertility medications could cause cancer. Currently, there is no evidence of any adverse effects of fertility drugs on cancer risk and outcomes. 

find-support

If you are a person with an inherited mutation, who is considering or undergoing assisted reproductive technology, you are  not alone. Many people in the FORCE community have used ART in order to become pregnant. 

  • Register for the FORCE Message Boards to connect with others who share your situation. Once you register, you can search the board for keywords like "pregnancy" or "assisted reproductive technology."
  • FORCE's Peer Navigation Program will match you with a volunteer who shares your mutation and situation and provide you with a free resource guide. 
  • Contact the FORCE impact leaders in your area to link to local support groups and other resources. 
  • Attend a virtual support meeting in your area.
  • Read the stories from members of our community.
paying-for-service
  • RESOLVE: Sponsored by the National Infertility Association, Resolve provides a comprehensive list of financing, loan, and other programs aimed at easing the financial burden of infertility treatments.
  • SAMfund: The SAMFund gives young adult survivors the tools and resources to overcome their financial challenges and move forward with their lives. They provide grants to help offset the costs of family building options/procedures including egg, embryo or sperm storage, IVF, IUI, gestational carrier, surrogacy, adoption, or fertility testing.

Alliance for Fertility Preservation
The mission of the Alliance for Fertility Preservation is to Increase information, resources and access to fertility preservation for cancer patients and the healthcare professionals who treat them. Their exclusive focus is fertility preservation for cancer patients.

Ferring/Walgreens Heart Beat Program
Ferring Pharmaceuticals and Walgreens Specialty Pharmacy have developed the Heart Beat program to ease some of the financial burden for cancer patients. The program offers eligible patients select fertility medications at no cost.

LIVESTRONG Fertility
Once called Fertile Hope, the LIVESTRONG Fertility Discount Program helps reduce the cost of embryo freezing and egg freezing procedures at a reproductive center. It doesn’t provide grants to the patients, but instead works with companies and clinics to provide discounted services and donated medications for male and female cancer patients.

International Council on Infertility Information Dissemination
Each year, the International Council on Infertility Information Dissemination offers a national scholarship program designed to help couples who cannot afford IVF fertility treatments on their own. With this program, fertility doctors from respected fertility clinics from across the U.S. donate their services to needy couples. The program covers most of the basic IVF costs.Must meet criteria for infertility as defined by the American Society for Reproductive Medicine, and must demonstrate financial need.

The Cade Foundation
The Cade Foundation has helps couples by providing grants to those struggling with infertility. The grant, which has a limit of $10,000 per family, helps couples pay for fertility treatment costs associated with fertility treatments or domestic adoption.

Baby Quest Foundation
BabyQuest Foundation is a nonprofit organization whose goal is to grant financial assistance to those who cannot afford infertility treatments such as IUI, IVF, egg donation, and surrogacy. Applications are accepted from heterosexual, same sex couples, and singles.

clinical-trials
Last updated September 28, 2020