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 and egg retrieval
- egg fertilization
- egg and/or embryo freezing
- implantation and pregnancy
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 ) 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 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 ) 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 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 . 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.
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.
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NCT03011684: Fertility Preservation Using Tamoxifen and Letrozole in Estrogen Sensitive Tumors Trial (TALES). Letrozole plus gonadotropin and tamoxifen plus gonadotropin are currently used for fertility preservation in patients with estrogen-receptor-positive breast cancer, it is not clear which of the two might lead to improved oocyte yield.
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NCT01558544: Cryopreservation of Ovarian Tissue. The study hopes to contribute to the development of technologies of ovarian tissue freezing-thawing the preserve fertility. The study is open to women who will undergo treatment or surgery for cancer or women with an inherited mutation who are considering undergoing risk-reducing surgery.
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NCT03962257: The Use of an Online Learning and Consent Platform in Infertility Treatment. The purpose of this study is to assess if interactive multimedia tutorials (online videos) enhances patients' comprehensive understanding of assisted reproductive technology (ART) adding EngagedMD, an online library of interactive videos, compared to the usual consent and one-on-one teaching using a 15 question evaluation.