Fertility Options for Women With Ovarian Cancer
Most women who develop ovarian cancer are past childbearing age, but some women are not. If you have ovarian cancer and still wish to have children, be aware of the following:
How treatment for ovarian cancer affects fertility
Fertility refers to your ability to produce children. Some women who are treated for ovarian cancer still maintain their fertility, while others don’t.
You may still be able to become pregnant if you have only one ovary removed to treat the cancer. Keeping your fertility options while maintaining the healing potential of the treatment required for ovarian cancer can often be a complicated management decision. It is very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including ovarian cancer.
You may be infertile, meaning you cannot become pregnant without medical intervention, if you had any of these treatments for ovarian cancer:
Surgery to remove both of your ovaries.
Chemotherapy. Many chemotherapy drugs can cause the menstrual cycle to stop and disrupt the function of your ovaries.
Radiation directed at your pelvic area. Radiation can affect your ovaries’ ability to produce a mature egg.
If you had any of these treatments and you want to have children, see a reproductive endocrinologist. This is a doctor who specializes in infertility treatment. A multidisciplinary team approach, which includes a gynecologic oncologist and a reproductive endocrinologist, may be required.
Understanding your choices to treat infertility
A reproductive endocrinologist can fully explain your options for becoming a parent if you may be infertile after ovarian cancer treatment.. Your main choices are:
In vitro fertilization with a donor egg
If both of your ovaries were removed, but you still have your uterus, you may be eligible for in vitro fertilization. For this procedure, the egg from another woman is fertilized with sperm from your partner. Then the fertilized egg, called an embryo, is implanted into your uterus. You carry the baby to term.
This is how IVF works.
How a donor is used. The donor, typically a young woman, gets daily injections of hormones for up to 2 weeks. This increases the number of eggs in her ovaries. When the eggs reach maturity, a doctor removes them using a needle.
How you prepare for the donated egg. You take the hormones estrogen and progesterone to build up the lining of your uterus. Your doctor will tell you how often to take the hormones.
How the egg is fertilized and implanted in you. The donor’s mature eggs are put into a container and fertilized by your partner’s sperm or those of a donor.
After the egg is fertilized, the doctor uses a hollow tube (called a cannula) to place 1 to 3 embryos into your uterus. Two weeks later, your doctor will give you a pregnancy test. If you are pregnant, you continue taking the estrogen and progesterone. If you’re not, you will stop taking the hormones. You will bleed for a few days, similar to having your period.
Your chances of becoming pregnant depend on a few factors. These include the number and quality of the donor eggs, the quality of the sperm, the quality of the embryos, and the health of your uterus. This procedure offers a 30% to 40% chance of pregnancy and delivery. IVF is expensive and your insurance may not cover the costs of the infertility treatment. Some states have laws that require insurance to cover some of the costs of infertility diagnosis and treatments, but provisions in each state vary widely. You can get more information by calling your state’s Insurance Commissioner’s office.
If you are infertile, another option is surrogacy. With surrogacy, another woman carries the baby. She is called the surrogate mother. She becomes pregnant using either her eggs or the eggs of another donor. She is artificially inseminated with the sperm from your partner, and carries the child to term. You might choose surrogacy if your uterus was removed or is not healthy, or you have other health issues that may make a pregnancy risky.
When the child is born, the surrogate mother turns the baby over to you and your partner and gives up her parental rights. You can then legally adopt the baby.
Surrogate arrangements are usually set up by contracts arranged through agencies. There are different types of agencies. Ask your doctor for a recommendation. In some states, it is legal for a surrogacy to be arranged independently. In both situations, the infertile couple pays all of the surrogate mother’s expenses. Surrogacy is often a rather expensive option and can cost tens of thousands of dollars.
Adoption is another option when you are infertile. You have many choices. You will need to decide whether you wish to have an open or closed adoption. This refers to whether the identities of biological and adoptive parents are available to each other. You’ll also need to decide whether you wish to adopt an infant, toddler, or older child. Another consideration is whether you wish to adopt a child within your own, or another, country. Be aware that some agencies and countries require that cancer survivors be off treatment and cancer-free for a certain amount of time before allowing them to apply for adoption.
Advances in infertility treatment
Doctors and researchers are currently exploring ovarian tissue freezing, a new way to help infertile women become pregnant. A doctor does a biopsy or resection of some of the ovary and freezes the tissue. The frozen cells can be saved and later put back into the woman when she is ready to become pregnant. Another recent advance in infertility treatment is egg freezing. Eggs may be removed and fertilized, and the embryos may be frozen for use at a later date. The decision to attempt this treatment depends on whether there is good ovarian reserve and whether the gynecologic oncologist thinks there is no cancer in the good ovary.
Dealing with the emotions that accompany ovarian cancer and infertility
Dealing with the emotions that often accompany ovarian cancer and infertility can be difficult. You may wish to ask your doctor for a referral to a counselor, psychologist, or social worker. Resolve, a national nonprofit infertility advocacy organization, offers support services for infertility and information on adoption and surrogacy.
How to find a fertility specialist
Ask your oncologist to help you find a fertility specialist. You may also contact any of the following organizations:
American Society for Reproductive Medicine
1209 Montgomery Highway
Birmingham, AL 35216
International Council on Infertility Information Dissemination
P.O. Box 6836
Arlington, VA 22206
Resolve: The National Infertility Association
1760 Old Meadow Road, Suite 500
McLean, VA 22102