Really common questions women who have not yet started or completed their families ask after receiving a cancer diagnosis include:
"Why can cancer cause infertility?" and "Should I freeze my eggs before chemo?"
We spoke to Dr. Julie Lamb, Director of the Fertility Preservation Center of Excellence and board certified reproductive endocrinologist and infertility specialist at Pacific NW Fertility in Seattle to answer some of these questions.
Why can cancer or cancer treatment damage fertility?
Cancer treatment can effect fertility because it may require surgical removal of reproductive organs. Or it can expose reproductive organs to radiation or, most commonly, ovaries can be affected by chemotherapy. The time that cancer treatment takes also delays fertility, and this should also be considered.
Read more about cancer and fertility from the National Cancer Institute.
Do you advise cancer patients who have not yet started or completed their families freeze their eggs, if possible?
Every patient is so different, and there are so many variables affecting this decision. I encourage every patient to talk with a reproductive endocrinologist and learn about egg freezing, so they can make an informed decision about what’s best for them."
Some patients will want to freeze eggs even if it only gives them a 10% chance of future conception, others will chose not to because their chance is only 50%. There are many beautiful ways to build families, it is important to know your options and chose the one that’s best for you.
Read more about what egg freezing is and what exactly it involves.
Do the options depend on what kind of cancer a woman has been diagnosed with? (For example, if she has ovarian cancer or cancer elsewhere in the body, or if the cancer is hormone-responsive?)
Absolutely. All of these factors weigh into this type of decision. It is possible to freeze eggs if you have ovarian cancer. In some instances women have one ovary surgically removed and can undergo ovarian stimulation on the second ovary to produce mature eggs for freezing.
However, timing is an important consideration: it's not usually possible to undergo fertility preservation and chemotherapy at the same time, so treatment schedules must be taken into account. Doctors will assess each individual patient's case depending on the exact diagnosis and treatment needed.
Could freezing eggs delay treatment, or can it be done swiftly?
Freezing eggs prior to cancer treatment often can happen very quickly. And usually does not delay treatment starts.
Whilst delaying treatments such as chemotherapy is unlikely to form part of a treatment plan, or be desirable to doctor or patient, oncologists can work with reproductive endocrinologists (fertility doctors) to try to help patients craft a fertility preservation plan that works around cancer therapies, wherever possible.
Is it possible to freeze ovarian tissue instead of eggs? - what could be the advantage?
This is also possible but requires laparoscopic surgery to remove ovarian tissue. This is more invasive, more expensive and less successful but can also be considered.
Read more about ovarian tissue freezing and freezing immature eggs.
What advice would you give to women to proactively detect/prevent female cancers like ovarian cancer?
Talk to your doctor. Know your risks, consider genetic testing if you have a family history so you can make proactive decisions about your health, family building and fertility preservation options.
If you have any concerns, please contact your doctor or medical provider to receive advice based on your own individual symptoms and medical history. ________________________________________
ELANZA Guest Expert:
Dr. Julie Lamb
Fertility Doctor
Julie Lamb, MD, FACOG is a board certified reproductive endocrinologist and infertility specialist at Pacific NW Fertility in Seattle and serves as clinical faculty at the University of Washington.