Fertility preservation

What is fertility preservation?

Fertility preservation is an option available for people wanting to save their eggs, sperm, embryos or reproductive tissue such as ovarian or testicular tissue for future use.

It can be used ahead of a medical treatment that may cause infertility – such as chemotherapy or radiation therapy – or if you’re looking to delay having biological children until later in life.

Why is fertility preservation used?

Medical diagnosis, age and lifestyle choices are all factors that can influence your decision to consider fertility preservation.

Whether you’re not wanting to consider children now but would like the option later in life, or are looking to undergo gender-affirming treatments that will alter your reproductive abilities, freezing and storage give you choice with your fertility.

When it comes to your health, there are a number of treatments that can impact your fertility, such as:

• chemotherapy
• radiotherapy
• hormone therapies
• surgeries to reproductive organs

How does cancer treatment affect fertility?

Cancer treatments affect fertility in different ways:

• Chemotherapy: alkylating agents and cisplatin used for chemotherapy can cause infertility. Younger women are less likely to become infertile, however, it would depend on the length and intensity of chemotherapy. Young age on its own can’t always protect from the unwanted effect of chemotherapy drugs on future fertility
• Radiation therapy: can be more damaging than chemotherapy, depending on the intensity and location of the radiation field
• Other cancer medications: there is still a lot of uncertainty regarding new immunotherapy effects
• Surgery: such as the removal of the uterus, ovaries or testicles
• Time/age: with some cancers, even if treatment was successful straight away, patients may be advised to postpone the pregnancy for several years, which may make patients much older, where their chance of conceiving will significantly drop even without any chemotherapy drugs

What to expect during fertility preservation?

Before cancer treatment we provide a full assessment of your fertility potential, we can then advise on reproductive function after cancer treatment.

Based on your individual circumstances, we will determine the most suitable fertility preservation option for you.

Types of fertility preservation

There are two main types of fertility preservation:

• freezing of eggs, sperm, embryos and ovarian/testicular tissue for future use
• the minimisation of cancer treatment’s effect on reproductive tissues

Female fertility preservation

There are various types and methods of female fertility preservation:

Removal and freezing methods

• Egg freezing – harvesting and freezing your unfertilised eggs.
• Embryo freezing – involves harvesting and fertilising eggs with the sperm of your partner/donor sperm before freezing them to be implanted in the future.
• Ovarian tissue freezing/ ovarian tissue cryopreservation (OTC) –  involves removing a part of or a whole ovary that produces eggs and storing it while you undergo treatment, before transplanting it in the future. This could be for female patients who cannot delay cancer treatment or are too young to undergo hormonal stimulation.

Methods to minimise the impact of cancer treatment on fertility

• Ovarian transposition – involves repositioning the ovaries surgically away from the radiation field, offers more protection during radiation therapy.
• Radiation shielding – placing small lead shields over the ovaries to reduce radiation exposure.
• Prescribing medication to suppress ovarian activity during chemotherapy.

Male fertility preservation

• Sperm freezing – men can undergo sperm cryopreservation, which freezes and stores sperm at a clinic or sperm bank for future use.
• Testicular tissue freezing – if men have the inability to produce ejaculate, testicular tissues could be collected and frozen.
• Radiation shielding – if undergoing cancer treatment men can also have radiation shielding which places small lead shields over the testes to reduce radiation exposure.

As part of all fertility treatments we offer supportive fertility counselling and can advise medical professionals who are considering referring their patients to our services.

After cancer treatment

The frozen sperm, eggs or embryos can be used if you wish to try for a baby after your cancer treatment is completed.

We’ll assess your fertility potential and advise on reproductive function. Regular periods after treatment do not guarantee normal fertility. However, absence of periods does not always mean you can’t get pregnant. So, advice on appropriate contraception is also important while you are recovering from cancer and its treatment.

We’ll also provide specialist advice:

• about HRT and other aspects of women’s health in cases of early menopause
• on men’s health in cases of testicular failure or male hypogonadism secondary to radiotherapy treatment
• for women who developed Vaginal Graft Versus Host Disease following bone marrow transplantation

Fertility treatment can be provided where possible and we can advise on alternative options including surrogacy and donor treatments.

Benefits of fertility preservation

Fertility preservation can be recommended for many reasons and the potential benefits include the following:

• you can have a child at some point in the future
• it is a viable option for both sexes
• it can be an option for some children of both sexes
• you may have more time to find the right partner, making you less anxious about meeting a suitable partner within a certain timeframe.
• you can preserve your eggs, sperm, embryos or reproductive tissue before medical treatment
• your eggs could be protected from disease and ageing
• the impact of medical treatments on your fertility can be reduced

Risks of fertility preservation

It is important to understand the potential risks and side effects attached to fertility preservation:

• The process of egg freezing requires at least 2.5 weeks and in some circumstances, chemotherapy cannot be delayed so much and needs to start much faster
• Ovarian stimulation with a view of harvesting eggs/embryos involves taking injections for an overall of 2 weeks. This process can cause ovarian hyperstimulation syndrome (OHSS) which is associated with an increased risk of blood clots and accumulation of fluid in the tummy. On occasions, this fluid needs to be drained. However, we use slightly different protocols that make the risk of the above complication very low (less than 1%).
• Certain procedures (including suction devices) if unused for egg and sperm collection can result in bleeding and potential infection.
• Ovarian stimulation can increase oestrogen levels. Some cancers may be oestrogen dependent and there is a theoretical risk that ovarian stimulation may increase the risk of cancer growth. However, we can provide anti-oestrogen tablets to reduce the amount of circulating during stimulation. Until today the evidence is reassuring and shows no negative effect on cancer outlook for patients who had oestrogen depended on tumour and needed to have ovarian stimulation.
• When laparoscopic procedures are used – such as in the removal of ovaries – there is an element of risk, including infection and injury to tissues or organs. Anaesthesia also carries a degree of risk of adverse reactions.
• There is a risk that ovarian transposition – which repositions the ovaries ahead of ovarian transposition – can lead to the rotation of relocated ovaries, and ovarian cysts developing.