Understand your female options after cancer treatment, from preserved embryos to fertility testing for future family planning.
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Overview
Fertility options after cancer treatment may be limited. Your ability to become pregnant depends on the effects of cancer treatment on fertility, your age and whether you have been affected by premature ovarian insufficiency or early menopause.
Options to consider include:
- conceiving naturally
- using eggs or embryos harvested and stored before treatment, implanted into either your body (IVF) or a surrogate
- freezing eggs or embryos after treatment ends for later use (if your ovaries are still working)
- using donor eggs or embryos.
Checking fertility after treatment
Before trying to conceive, you may want to do some tests to see how your fertility has been affected. While there is no reliable way of checking how treatment has affected your fertility, these tests provide your doctors with some information. You can ask them how much the tests will cost.
Blood tests
You may have a variety of blood tests to measure the levels of hormones in your body, including follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), oestrogen (oestradiol) and luteinising hormone (LH).
For more information on these tests, talk to your doctor or call Cancer Council 13 11 20.
Ultrasound
An ultrasound uses soundwaves to create a picture of the cervix, uterus, fallopian tubes and ovaries. A technician will insert an ultrasound wand, covered with a disposable plastic sheath and gel, into the vagina.
This is called a transvaginal ultrasound. During an antral follicle count (AFC), the ultrasound wand is inserted into the vagina to show the number of follicles in the ovaries. Each follicle contains a single immature egg. A scan of the abdomen is an option for younger people.
Natural conception
You may be able to conceive naturally after finishing cancer treatment if your ovaries are still releasing eggs and you have a uterus. If fertility tests suggest it may be possible for you to get pregnant (see above), your medical team will encourage you to try for a baby naturally.
Even if your periods return after chemotherapy or pelvic radiation therapy, there is a high risk of early menopause. If menopause is permanent, you will no longer be able to conceive naturally.
Donor eggs and embryos
If after cancer treatment you go through menopause but have a healthy uterus, you could try for a pregnancy using eggs or embryos donated by another person. You may be able to use eggs or embryos from overseas, but there are strict rules about importing them into Australia. Donors cannot be paid but you can cover (reimburse) their medical expenses.
Using donor eggs
In most cases, eggs are donated by a family member or friend. Your fertility clinic may have an egg bank, but there is usually a long waiting list. All donors are required to have blood tests for infectious and genetic screening, answer questions about their genetic and medical information, and have counselling.
After the eggs are collected from the donor, they are combined with sperm from your partner or a donor using IVF.
Using donor embryos
Donor embryos usually come from people who still have frozen embryos after they’ve had successful IVF treatment. Embryos may be donated for ethical reasons (instead of discarding the embryos) or compassionate reasons (to help someone with infertility).
If you use a donated embryo, you will have counselling to answer all your questions and plan ahead. It’s also a good idea to seek legal advice before proceeding. When you are ready, you will take hormones to prepare your uterus for pregnancy. When your body is ready, the embryo will be thawed and implanted into your uterus using IVF.
A child born from a donated embryo is deemed to be the child of the birth mother. Donors have no legal or financial obligation to the child.
Finding information about the donor
In Australia, fertility clinics can only use eggs, sperm and embryos from donors who agree (consent) that people born from their donation can find out who they are. This means that the donor’s name, address and date of birth are recorded.
People who opt to use donor sperm, must undergo a discussion with a fertility counsellor about how they will approach this topic with their donor-conceived children.
Once donor-conceived people turn 18, they are allowed to access identifying information about the donor. In some states, a central register is used to record details about donors and their donor-conceived offspring.
In states with a central register, parents of donor-conceived children, and donor-conceived people who are over the age of 18 can apply for information about the donor through the register. In states and territories where there is no central register, people who want information about their donor can ask the clinic where the fertility treatment took place.
It is important to discuss possible issues for donor-conceived children with a fertility counsellor.
Uterus transplant is being studied in clinical trials. Talk to your doctor about the latest research and whether there are any suitable clinical trials for you.
I now understand what they mean by ‘information means control’. Seeking accurate, reliable information was a huge coping strategy for me.
Sonya
→ READ MORE: Male options before cancer treatment
More resources
Dr Sally Reid, Gynaecologist and Fertility Specialist, Obstetrics and Gynaecology (Adelaide) and Royal Adelaide Hospital, SA; Dr Sarah Ellis, Clinical Psychologist and Postdoctoral Research Fellow, Kids Cancer Centre, Sydney Children’s Hospital and UNSW, NSW; John Booth, Consumer; Hope Finlen, Haematology Nurse Consultant, Gold Coast University Hospital, QLD; Dr Michelle Harrison, Medical Oncologist – Gynaecological cancers, Chris O’Brien Lifehouse, NSW; Melissa Jones, Nurse Consultant, Youth Cancer Service SA/NT, Royal Adelaide Hospital, SA; Dr Violet Kieu, Clinical Director, Melbourne IVF and Fertility Specialist, The Royal Women’s Hospital, VIC; Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Stephen Page, Family and Fertility Lawyer, and Legal Practice Director, Page Provan, QLD; Ann Retzlaff, 13 11 20 Consultant, Cancer Council WA; A/Prof Kate Stern AO, Fertility specialist, Gynaecologist and Reproductive Endocrinologist, Royal Women’s Hospital and Melbourne IVF, VIC; Georgia Webster, Consumer.
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