Preserving Your Fertility Before Ovarian Cancer Surgery

Because the ovaries hold the eggs, having these organs removed will mean that you won't be able to have a typical pregnancy. Having your uterus removed will make you unable to carry a child. If the cancer is only in one ovary, doctors may be able to perform fertility-sparing surgery, preserving the uterus and one ovary, and then following up the surgery with chemotherapy. That option can have good results in some women with early-stage cancer.

Surgery isn’t the only concern as chemotherapy can also impact future fertility. The chemo drugs – including carboplatin and cisplatinhave been linked with impaired fertility.  It targets quickly dividing cells, which include the cells that form eggs. Chemo can also alter levels of hormones needed to conceive and carry a pregnancy. This may result in a loss of fertility for some women that can be either temporary or permanent. But you can discuss the likelihood of damage with your gynecologic oncologist, and see if there are alternatives that would be equally effective.

Still, undergoing these treatments doesn't mean that you have to give up on your plans of having children.

Having the Fertility Conversation

"If a woman is diagnosed with ovarian cancer and has not yet finished having children, there are options," says Dr. Kimberly Resnick, gynecologic oncologist at MetroHealth in Cleveland. "Now, there are times where the disease is so advanced and we simply need to move too quickly in order for us to even begin to discuss fertility options, but those times are rare."

The earlier your cancer is diagnosed and particularly the earlier the stage of your ovarian cancer is, the higher the likelihood that you can discuss and pursue fertility options with your doctor. It's important to have that conversation before surgery. Doctors don't always know in advance how extensive the cancer is, and which of the reproductive organs they'll be able to preserve.

The doctor who treats your cancer can refer you to a fertility specialist, usually a reproductive endocrinologist. This specialist can evaluate your situation and recommend options for preserving your fertility.

Freezing Your Eggs or Embryos

One fertility preservation method is to freeze your eggs or embryos, called cryopreservation, before your surgery. First, you'll get hormones (as long as your doctor determines they're safe for you) that stimulate your ovaries to produce more eggs. Then, your fertility specialist will collect a few eggs.

You can choose to either freeze your eggs, or have them fertilized with your partner's sperm (with in vitro fertilization) and then freeze the resulting embryo. Once your treatment is complete, the egg can be thawed and fertilized, or the embryo can be thawed and implanted in your uterus.

If your cancer was so advanced that you didn't have time to see a reproductive endocrinologist before surgery or chemotherapy, or if it's unsafe for you to receive egg-ripening hormones, you still might have options. Your surgeon can give one of the ovaries removed during surgery to your reproductive endocrinologist, who may be able to retrieve and freeze immature eggs. This procedure is still considered experimental, but it may be available at some larger fertility centers.

The cost of fertility preservation can vary, depending on where you have it and how it's done. If you're concerned about how to pay for fertility treatment, programs are in place to help. "The majority of infertility and reproductive endocrinology treatment centers, especially at large cancer centers, have special programs for young women who are diagnosed with cancer to help defray some of the costs," says Dr. Resnick.

Before you embark on ovarian cancer treatment, you have a number of decisions to make. Fertility may not be at the forefront of your mind when your primary focus is on stopping the cancer. But if you're still in your childbearing years, it's an important discussion to have with your doctor. If your oncologist doesn't bring up the subject, ask for a referral to a reproductive specialist.

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