Female options before cancer treatment

In this section we discuss ways you can preserve your fertility before starting cancer treatment. It’s ideal to discuss the options with your cancer or fertility specialist at this time. For more on this, see Making decisions.

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Discussing your options

Ask your cancer specialist how long you have to consider your options. In many cases, you can wait a week or two before starting cancer treatment. Be sure to understand the risks of each fertility option and keep in mind that no method works all of the time.

If you didn’t have an opportunity to discuss your options before starting treatment, you can still consider your fertility later, but there may not be as many choices available. For more on this, see Female options after cancer treatment.

Options for preserving fertility in females

Wait and see

What this is
  • when no method is used to preserve fertility.
When this is used
  • when you don’t have time to consider fertility preservation
  • when you choose to start cancer treatment immediately
How this works
  • requires no action
Considerations
Pregnancy rate
  • depends on age and cancer treatment

Egg or embryo freezing (cryopreservation)

What this is
When this is used
  • when you want to store eggs or embryos for the future – they can be stored for many years
  • legal limits on how long eggs and embryos can be stored are different in each state and territory
  • your fertility clinic can advise about time limits and the cost of storage
  • when you are ready to have a child, the frozen egg will be fertilised using IVF or the embryo will be implanted in your uterus
How this works
  • egg and embryo freezing is part of IVF – the most common and successful method for preserving female fertility
  • one cycle of IVF can take 2–3 weeks
  • egg collection is a minor procedure in an operating theatre
Considerations
  • need time to have IVF before cancer treatment – your cancer specialists will advise how quickly treatment should begin
  • don’t need to have a partner to freeze eggs
  • to freeze an embryo, you need to have a male partner at both the start and end of treatment, as both partners have to agree to implant the embryo after treatment
  • talk with your fertility specialist about whether to freeze eggs, embryos or a mix of both
Pregnancy rate
  • freezing eggs is equally as effective as freezing embryos
  • for every 10 eggs frozen, you can expect to get 1–4 embryos
  • depending on age, the success rate of the fertility clinic and the stage the embryos are stored at, there may be a 25–40% chance per cycle of a frozen embryo developing into a pregnancy

Ovarian tissue freezing (cryopreservation)

What this is
  • the process of removing, slicing and freezing tiny pieces of tissue from an ovary so it can be used later
  • legal limits on how long ovarian tissue can be stored are different in each state and territory
  • your fertility clinic can advise about time limits and the cost of storage
When this is used
  • if there isn’t a lot of time before treatment
  • if taking hormones to encourage egg production is unsafe
  • if there is a high risk of infertility
  • if the person hasn’t gone through puberty
  • can be used in addition to egg freezing
How this works
  • tissue is removed from your ovaries during keyhole surgery (laparoscopy); if you have abdominal surgery as part of cancer treatment, tissue can be removed at this time
  • tissue is frozen until needed
  • when you are ready to conceive, some ovarian tissue is thawed and put back (grafted) into the ovary
  • tissue may produce hormones and eggs may develop
Considerations
  • there is a risk that storing tissue before treatment begins means it will contain cancer cells, and you may not want to put this tissue back into your body
  • this risk is higher for people with leukaemia
  • it’s important to discuss this risk with your doctor
Pregnancy rate
  • around a third of people who have had ovarian tissue put back have become pregnant
  • to date, about 170 births worldwide from ovarian tissue removed after puberty and several births from ovarian tissue removed before puberty

Ovarian transposition (oophoropexy)

What this is
  • a type of fertility-sparing surgery
  • it involves surgically moving one or both ovaries to preserve their function
When this is used
  • when the ovaries are in the path of radiation therapy
How this works
  • one or both ovaries are moved away from the field of radiation and stitched in place
  • this may lower the amount of radiation your ovaries receive
Considerations
  • may cut off blood supply, causing loss of ovarian function
  • not always successful
Pregnancy rate
  • depends on your age, the amount of radiation that reaches the ovaries and if you start menstruating again

Trachelectomy

What this is
  • a type of fertility-sparing surgery
  • it removes part or all of the cervix, the upper part of the vagina, and lymph nodes in the pelvis
  • the uterus, fallopian tubes and ovaries are left in place
When this is used
  • for small tumours found only in the cervix
How this works
  • the cervix is partially or completely removed, but the uterus is left in place and stitched partially closed
  • this opening is used for menstruation and for sperm to enter
Considerations
  • you will be at higher risk of having a miscarriage and having the baby prematurely
  • you may have a stitch placed in what remains of the cervix to reduce the risk
Pregnancy rate
  • it is possible to become pregnant after a trachelectomy

GnRH analogue treatment (ovarian suppression)

What this is
  • gonadotropin-releasing hormone (GnRH) is a long-acting hormone used to cause temporary menopause
  • reducing activity in the ovaries may protect eggs from being damaged
When this is used
  • during chemotherapy
How this works
  • you will have hormone injections 7–10 days before cancer treatment starts or during the first week of treatment
  • injections continue every four weeks until cancer treatment has finished
Considerations
  • may be recommended as a backup to other fertility options or as the only method used to help prevent loss of ovarian function
  • can affect bone density so may need menopause hormone therapy if used for more than six months
Pregnancy rate
  • studies show this treatment may help some people

How in-vitro fertilisation (IVF) works

in vitro fertlisation process

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Additional resources

This information was last reviewed in May 2020. View who reviewed this content.

Dr Ying Li, Gynaecologist and Fertility Specialist, RPA Fertility Unit, Royal Prince Alfred Hospital, NSW; Dr Antoinette Anazodo, Paediatric and Adolescent Oncologist, Sydney Children’s Hospital and Prince of Wales Hospital, NSW, and Lead Clinician for Youth Cancer NSW/ACT; Paul Baden, Consumer; Dawn Bedwell, 13 11 20 Consultant, Cancer Council Queensland; Maurice Edwards, Special Counsel, Watts McCray Lawyers, NSW; Helena Green, Clinical Sexologist and Counsellor, InSync for Life, WA; Dr Michelle Peate, Program Leader, Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, The University of Melbourne, VIC; A/Prof Kate Stern, Gynaecologist and Reproductive Endocrinologist and Head, Fertility Preservation Service, Royal Women’s Hospital Melbourne, The University of Melbourne, VIC; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Resea ch Institute (THRI), School of Medicine, Western Sydney University, NSW; Renee Van Den Bosch, Consumer.

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