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Female patients

Cancer treatments can have a number of different effects on female fertility:

  • Delay to conception

Most women will be advised to delay conceiving for a period of time following cancer treatment. Female fertility declines sharply in a woman's mid to late thirties and delay can significantly reduce the chance of conception.

  • Chemotherapy

Oocytes (eggs) are highly susceptible to the effects of chemotherapy. Women treated with chemotherapy are therefore at risk of oocyte damage which may ultimately result in failure of the ovaries. The risk of ovarian failure is higher with increased dose and duration of chemotherapy and with particular types of chemotherapeutic agent. It is also more likely in women who already have a reduced reserve, ie, older women.  Periods may stop during chemotherapy, but may come back up to nine months after chemotherapy treatment has finished. Although some patients will retain eggs in their ovaries after chemotherapy treatment, unfortunately many will suffer premature ovarian failure and would need to consider treatment with donated oocytes if they wish to conceive.

  • Radiotherapy

Whilst most chemotherapy treatments are administered systemically (throughout the body), most radiotherapy treatments are directed to a local area. Therefore toxicity from radiotherapy is usually limited to the area treated. Pelvic radiotherapy is highly toxic to oocytes and it is extremely rare for women to retain significant ovarian reserve after such treatment. Additionally, pelvic radiotherapy is associated with damage to the uterus (womb) caused by fibrosis and a reduction in blood flow. Following pelvic radiotherapy, it is likely that the woman would need to consider fertility treatment using donated oocytes and a surrogate host.

  • Surgery

Surgery for gynaecological malignancies can impact on a woman's chance of pregnancy in the future. Fertility options may therefore include the need for treatment with donated eggs or a surrogate host. It is important that a woman's desire for future pregnancies is always considered and that fertility sparing treatment is performed whenever possible. This is always discussed with the woman and the surgeon responsible for the woman's cancer treatment.


Fertility preservati on options for women

We feel that all young women diagnosed with a malignancy should be seen by a fertility specialist to discuss the effect that their cancer treatment may have on their fertility and whether there is a possibility of storing eggs or embryos for future use:

  • Oocyte cryopreservation (egg freezing)

If a woman does not have a long term partner, she may attempt to store eggs. Following a cycle of ovarian stimulation and egg recovery (similar to that of an IVF cycle), all retrieved eggs are cryopreserved by the process of vitrification. Vitrification freezes eggs extremely rapidly and appears to be the optimal method. Mature eggs are very large cells and the chromosomes within them are not held within a nucleus. These properties make eggs very sensitive to disruption from the freezing process.  In the UK, frozen eggs can be stored for up to 55 years. When a woman returns after completion of her cancer treatment, the frozen eggs are thawed and each surviving egg injected with a single sperm using ICSI (intra-cytoplasmic sperm injection). Although more than 90% of eggs survive the freezing process and fertilisation rates are similar to those seen with 'fresh' eggs, the resulting embryos tend to be of poorer quality, resulting in lower pregnancy rates. More than 1000 babies have been born worldwide following egg freezing, but the technique still has a relatively poor success rate, compared to treatments using non-frozen eggs.

  • Embryo cryopreservation (embryo freezing)

If the woman is in a stable relationship, the couple may wish to freeze embryos instead of eggs. The woman undergoes a cycle of ovarian stimulation and egg retrieval as in conventional IVF.  On the day of egg collection, an attempt to fertilise all mature oocytes is made, either by conventional IVF or, if the sperm is of poorer quality, ICSI. The following day all fertilised oocytes are frozen at the 'pronuclear' one cell stage and, in the UK,  may be stored for up to 55 years. Embryo freezing is a relatively successful procedure and follow up studies on babies born are reassuring. Approximately 1 in 3 couples will conceive following embryo freezing if the female partner is under 35 years of age. Although more successful than egg freezing, embryo storage should only be carried out for couples in a stable relationship as, if the couple separate, the male partner may withdraw his consent for continued storage and treatment. As a result, the embryos would have to perish.


Available leaflets:

Fertility care for women diagnosed with cancer