Assisted Reproductive Technology

Assisted Reproductive Technology

Certain types of cancer and treatments (such as surgery, radiation, chemotherapy, immunotherapy and targeted therapy) may damage the female reproductive system and increase the chance of infertility. Risk-reducing surgery to remove the ovaries, tubes or uterus also ends fertility.

Assisted Reproductive Technology (ART) is a multistep process which provides people the option to have biologic children in the future, even if they undergo menopause because of treatment or surgery. The overall process can take anywhere from 2 to 3 weeks from start to finish. For people diagnosed with cancer, this option requires delaying 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.

Note that when we use the terms "female" and "women" we are referring to people assigned female at birth. Here are the steps involved in ART:

Ovulation induction and egg retrieval

Ovulation induction allows the eggs to reach maturity before they are removed from the ovaries. 

• 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 follicles are mature (reach 18mm in size), the fertility doctor performs a minor procedure under light sedation to extract eggs using ultrasound as a guide. This is an outpatient and minimally-invasive procedure that takes less than 15 minutes.

Egg fertilization and embryo transfer

Once the eggs are removed from the 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, unfertilized eggs can be removed, frozen, and placed in long-term storage. Unlike embryo freezing, egg freezing does not require sperm to be available for immediate fertilization. This is an ideal option for single women, or those who want to reserve the option to one day have children with a future 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, using light sedation, a fertility specialist extracts the eggs using ultrasound as a guide. This 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 transfer process 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 people newly diagnosed with cancer

Some people 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. It's important for people to speak with their oncologist to understand the risks and benefits of this option. 

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 further increase their risk for cancer. Currently, there is no evidence that fertility drugs or ART affect cancer risk and outcomes for people with an inherited mutation.. 

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