Fertility Preservation - UNC School of Medicine
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Treatment Options
Depending on your type of cancer and treatment plans, several options for fertility preservation may be available to you at the University of North Carolina Medical Center. A brief description of these choicies is listed below. For complete details, please schedule an appointment with one of our Reproductive Endocrinologists, who can review all of these options in more detail. Also, please refer to the Fertile Hope website for more information regarding treatment options for women and for men. Note that often, fertility treatments are not covered by insurance -- you can learn more about the costs when you meet with the Reproductive Endocrinologist.
Options for Women Prior to Chemotherapy or Radiation
- Emergency in vitro fertilization (IVF) with embryo freezing
- Emergency ovarian stimulation with ooctye (egg) freezing
- IVF using a protocol specific for women with hormone-sensitive cancers
- Ovarian tissue freezing
- Laparoscopic ovarian transposition
Options for Women During Chemotherapy or Radiation
Options for Women After Chemotherapy or Radiation
- Natural conception
- Transfer of frozen embryos into the uterus
- IVF with one's own eggs
- IVF with donor eggs or embyros
- IVF using a surrogate to carry the pregnancy
- Adoption
Options for Men Prior to Chemotherapy or Radiation
Options for Men After Chemotherapy or Radiation
More Information:
- In vitro fertilization (IVF) with embryo freezing: An established treatment in which hormone injections are given to stimulate the growth of eggs that are removed from the ovaries in an outpatient procedure. The eggs are fertilized immediately, with fresh or frozen sperm from the partner or an anonymous donor, to create embryos that are frozen and stored. The process takes 2-6 weeks, depending on the woman's menstrual cycle. Treatment protocols are designed for the individual, depending on the amount of time available and the overall cancer treatment plan.
- Ovarian stimulation with oocyte (egg) freezing: An experimental treatment in which hormone injections are given to stimulate the growth of eggs that are removed from the ovaries in an outpatient procedure, frozen immediately, and stored. Egg freezing offers fertility preservation to women who do not have a partner and do not want to use donor sperm. The process takes 2-6 weeks, depending on the woman's menstrual cycle. Treatment protocols are designed for the individual, depending on the amount of time available and the overall cancer treatment plan.
- Modified IVF protocol for women with hormone sensitive cancers: A specialized experimental treatment protocol designed for women with hormone sensitive cancers to limit the increase in estrogen levels that results from the hormone injections given to stimulate the growth of eggs. Treatment results in estrogen levels only slightly higher than in natural menstrual cycles, but still yields adequate numbers of eggs. The eggs may be frozen immediately, or fertilized with partner or donor sperm to create embryos that are frozen and stored.
- Ovarian tissue freezing: An experimental treatment strategy involving outpatient surgery to remove one ovary that is frozen for future use. Current research is focused on developing methods to stimulate the growth and development of eggs in the laboratory. Although that capability does not yet exist, there is reason to expect that it will become possible in the years ahead. This strategy is the only one available for girls who have not yet gone through puberty and is an option for women whose cancer treatment plan does not allow time for egg or embryo freezing.
- Laparoscopic ovarian transposition: Outpatient surgery to move the ovaries out of the area affected by planned radiation therapy.
- Leuprolide Acetate treatment: A common, but still unproven, treatment involving injections of a drug that turns off the ovaries temporarily. The hope is to protect ovaries from injury due to chemotherapy.
- Natural conception: Embryos frozen before cancer treatments can be thawed and transferred to the uterus. Usually, treatment with medications will be needed to properly prepare the uterine lining to receive the embryos. Usually, even infertile women and women in whom cancer treatments cause a premature menopause are able to carry a pregnancy normally after transfer of previously frozen embryos. If the uterus has been removed, frozen embryos may be transferred to the uterus of another woman who serves as a gestational surrogate. Frozen embryos are stored in small groups in separate vials. Depending on the number of frozen embryos available, there may be an opportunity to have more than one embryo transfer procedure and chance to conceive.
- Transfer of frozen embryos into the uterus: Embryos frozen before cancer treatments can be thawed and transferred to the uterus. Usually, treatment with medications will be needed to properly prepare the uterine lining to receive the embryos. Usually, even infertile women and women in whom cancer treatments cause a premature menopause are able to carry a pregnancy normally after transfer of previously frozen embryos. If the uterus has been removed, frozen embryos may be transferred to the uterus of another woman who serves as a gestational surrogate. Frozen embryos are stored in small groups in separate vials. Depending on the number of frozen embryos available, there may be an opportunity to have more than one embryo transfer procedure and chance to conceive.
- IVF with donor eggs: Infertile women and women whose treatment causes a premature menopause who did not have the opportunity to freeze eggs or embryos in advance of their cancer treatment may choose to attempt pregnancy by IVF, using eggs obtained from a healthy young donor. Eggs may be donated by a known donor (a friend or relative) or by an anonymous donor matched to the patient’s specific preferences. The egg donor receives hormone injections to stimulate the growth of eggs that are removed from her ovaries and fertilized with partner or donor sperm to create embryos that are transferred to the patient’s uterus. Usually, treatment with medications will be needed to properly prepare the uterine lining to receive the embryos. Egg donation IVF is the most successful infertility treatment available and offers more than a 50% chance for a successful pregnancy.
- IVF with surrogate gestational carrier: A gestational surrogate is a woman who carries a pregnancy on behalf of another woman who has no uterus or has a medical condition that would make pregnancy a serious health risk. Embryos resulting from the union of the patient’s eggs and her partner’s sperm are transferred to the surrogate who receives medications to prepare her uterus for implantation. The child is the genetic offspring of the couple and has no genetic relationship to the surrogate. Gestational surrogates also may carry pregnancies created by combining donor eggs with donor sperm.
- Adoption: Most adoption agencies do not exclude cancer survivors as potential parents, but some agencies require potential parents to be cancer-free for a certain interval of time (5 years, for example). The adoption process itself can take time (from 6 months to as much as 3 years or more) and associated costs vary greatly.
- Sperm freezing: Sperm banking is possible at the Andrology lab at UNC. Men provide a semen sample, either at home or at our Andrology lab. Multiple donations are recommended if possible, but even one sperm may be enough for conception using ICSI (Intracytoplasmic Sperm Injection). Sperm can be frozen indefinitely and future pregnancy rates depend on your female partner's age and fertility status, the method of assisted reproduction (inseminations or IVF) and the quality of your sperm.
- Testicular sperm extraction or testicular tissue freezing: Testicular sperm extraction involves an out-patient procedure to recover sperm from the testes of men who do not have sperm in their ejaculate. Testicular tissue freezing involves an outpatient surgical procedure that removes testicular tissue (including the cells that produce sperm) and then freezes and stores it for future use. It is available for men, before or after puberty. In many cases it is the only option for prepubescent boys. The procedure is experimental with no live births to date, but shows promise for the future.