Every Day

Aug - Dec 2006 Issue

Preserving Fertility for Women With Cancer

Gloria Halverson, MD

Medical College of Wisconsin Obstetrician/Gynecologist
Named one of the “Best Doctors in America®” 2006 by Best Doctors, Inc.

Cancer treatment — radiation, chemotherapy and surgery — can save a girl’s or woman’s life, but it may also impair her fertility. Treatments for other diseases and certain autoimmune disorders also may impair fertility. Today, these treatments don’t have to end the hope of having a family. Gloria Halverson, MD, discusses methods to preserve female fertility.

Q. How can cancer treatment affect a girl’s or woman’s fertility?

The survival rates for women following cancer treatment have risen dramatically in the last few years. Unfortunately, these treatments can result in the loss of fertility. Each year, 76,000 men and women in the United States receive cancer treatment or other treatments that place them at risk for infertility.

In girls and women, chemotherapy, radiation and surgery can damage or destroy the ovaries. When ovarian function is damaged or destroyed, women stop producing female hormones, go into menopause and lose their ability to bear children.

If a female has radiation treatment to the lower abdomen, there is a risk that the radiation could harm her ovaries, depending on the size and location of the tumor and the radiation dosage. Chemotherapy can also damage the ovaries, depending on the female’s age and the type and dosage of chemotherapy drug. For cancers that affect the female reproductive organs, the best treatment may be to surgically remove those organs, again resulting in the inability to bear children.

The effect of cancer treatment on female fertility varies depending on the type of chemotherapy or the intensity of radiation therapy a girl or woman receives. Another factor is the number of eggs in her ovaries before treatment. At puberty, a girl has about 500,000 eggs. This number declines to about 25,000 by age 37 and to about 1,000 by age 51.

Q. What options do women have to preserve their fertility before or after cancer treatment?

New techniques at Froedtert & the Medical College of Wisconsin are providing hope for preserving or restoring fertility in girls and women. These include medication, ovarian tissue banking, ovary transposition and in vitro fertilization. A multidisciplinary team of reproductive specialists, geneticists, oncologists, nurse specialists, laparoscopic surgeons and obstetricians/gynecologists work together to offer women with cancer and other diseases many options — before and after treatment.

Q. How can medication help?

If chemotherapy could damage a woman’s ovaries, a medication, Lupron®, may be given to temporarily shut down ovarian function. Shutting down the ovaries — in effect, inducing a temporary menopause — may protect ovarian follicles from the damaging effects of chemotherapy.

Q. What is ovarian tissue banking?

This is an experimental procedure that shows promise for some women. It involves removing and freezing tissue from a girl’s or woman’s ovaries. This is done before she undergoes cancer treatment or other treatment that could impair her fertility.

In an outpatient procedure, a small amount of tissue in the outer layer of the ovary is removed. All of a woman’s eggs are found in this thin outer layer. The procedure is done using laparoscopy, a minimally invasive technique.

The tissue is frozen and stored. When the woman is known to be free from cancer and ready to attempt to become pregnant, she and her physician can discuss when to re-implant the tissue. The ovarian tissue can be re-implanted on or near an ovary, in abdominal tissue or in the arm. If implanted in the abdomen or arm, then the eggs must be used for in vitro fertilization, since they cannot be fertilized naturally.

Ovarian tissue banking has produced fertilized embryos and has also resulted in two successful pregnancies — one in this country and one in Europe.

Another reason to consider ovarian tissue banking is to reverse the symptoms of early menopause. When ovarian function is damaged or destroyed by cancer treatment, women stop producing female hormones and go into menopause. When the ovarian tissue is returned to the body, the hope is that it will begin to function normally and produce hormones. If this occurs, the symptoms of early menopause can be reversed.

Currently, ovarian tissue banking is being done as a clinical study at Froedtert & the Medical College. We were among the first in the country to offer this. To participate in the study, a multidisciplinary team determines a woman’s risk for losing ovarian function and other factors.

Q. What is ovary transposition?

To prevent damaging the ovaries if radiation therapy is needed, the precise area of the body that will receive the radiation is determined. If it appears the ovaries would be adversely affected by the radiation, surgery can be performed to move the ovaries out of the way of the radiation beam.

Q. What is in vitro fertilization (IVF)?

This is an assisted reproduction technique that fertilizes a woman’s eggs outside of her body. In a laboratory dish, sperm provided by the male are mixed with eggs that are removed from the woman’s ovaries. For a woman undergoing chemotherapy or radiation, the fertilized eggs (embryos) can be frozen. At a future time, the frozen embryos can be transferred to the woman’s uterus, with the hope that pregnancy will occur. Ideally, preparation for harvesting the eggs for IVF should begin at least six weeks before chemotherapy or radiation begins.

If it is not possible to use a woman’s own eggs for IVF, donor eggs from another woman can be used if the woman and her partner elect this option.