If you’ve been diagnosed with ovarian cancer and want to have a child, fertility preservation techniques or fertility treatments could help.
Some methods increase your chances of getting pregnant after cancer treatment. With others, you use donated eggs or embryos to carry a pregnancy to term. Third-party reproductive options, like adoption and surrogacy, mean you don’t need to go through a pregnancy to start or expand your family.
Techniques to Preserve Your Fertility
If you think you might want to have a child later, talk to your doctor before you start ovarian cancer treatment. Fertility-saving procedures are carefully timed with cancer care, so you have the best chance for recovery -- and parenthood. Even if you’re not sure whether you’ll eventually want a child, it’s a good idea to get a referral to a reproductive specialist.
Cancer surgery may involve removing reproductive organs, such as your ovaries, fallopian tubes, or uterus. Chemotherapy or radiation can affect hormone levels or damage your body in ways that keep you from getting pregnant. Chemo can also reduce the number of eggs in your ovaries (called low ovarian reserve) or put you into menopause.
Fertility preservation techniques allow you to save or protect eggs or embryos for future use. Your options include:
Embryo freezing (cryopreservation). This method preserves eggs that have been fertilized by sperm from your partner or a donor. You get hormone pills or injections, so your ovaries produce extra eggs to boost your odds of conception. Eggs are then removed from your ovaries and combined with sperm in a lab (a process called in vitro fertilization, or IVF). If the fertilization is successful, the embryo is frozen until you’re ready to have a child.
Egg freezing. With this technique, you store eggs for future use before fertilization, and thaw them later. You might prefer this method if you don’t currently have a partner and don’t want to use donor sperm. Egg freezing involves three steps:
- Ovarian stimulation, in which you take medication to stimulate your ovaries to produce multiple eggs at once
- Egg retrieval, when your doctor removes eggs from the follicles where they’ve matured
- Freezing, where your eggs are cooled to subzero temperatures, then frozen in special containers
Freezing methods aren’t without drawbacks. Egg retrieval may cause side effects, such as bloating, nausea, abdominal pain, diarrhea, or vomiting. If your cancer treatment permits, you may need more than one stimulation and retrieval cycle to get healthy eggs or embryos.
This is also a complex and expensive procedure, costing tens of thousands of dollars plus extra fees for embryo or egg storage. And while often successful, it doesn't always work.
Cryopreservation isn’t the only way to protect your fertility before ovarian cancer treatment. You may also consider:
Fertility-preserving surgery. If you have early-stage cancer that affects only one of your two ovaries, a surgeon can remove just that ovary along with the fallopian tube attached to it. This can make it possible for you to carry a pregnancy later on.
Ovarian tissue transplant. This experimental method involves removing ovarian tissue to prevent damage from cancer treatments, then freezing it. After you recover from treatment, a specialist thaws the tissue, then transplants it back. Once it starts working again, your eggs can be collected for in vitro fertilization.
Ovarian shielding. With this technique, a health care worker places a shield over your lower abdomen to protect your ovaries while you’re having radiation treatment.
Ovarian suppression. While you’re having chemo, you get monthly injections of drugs that block your ovaries from making the hormone estrogen. This helps protect your eggs from damage. Your period will pause during this treatment and you may have symptoms of menopause, such as hot flashes. It’s not clear how well this works to protect your fertility, though.
Ovarian transposition. In this minimally invasive procedure, a surgeon protects your ovary and fallopian tube by moving them away from tumors that radiation therapy targets. It doesn’t always successfully protect your ovaries, however.
Fertility Treatments After Ovarian Cancer
Some people are able to conceive naturally after being treated for ovarian cancer. Your doctor will probably recommend that you wait several months to 2 years before trying. This lowers your risk of birth defects caused by damage from cancer treatments. Your cancer is also more likely to return within 2 years after treatment.
But chemo or radiation can cause lasting fertility problems even if you don’t go into early menopause. You may need fertility treatments such as:
Intrauterine insemination (IUI): This is a type of artificial insemination. Your doctor collects a sample of semen from your partner or a donor. Around the time you ovulate, it's placed in your uterus so one or more of your eggs may be fertilized.
In vitro fertilization (IVF): You take fertility drugs to stimulate your ovaries. As with embryo freezing, your doctor collects the eggs and uses sperm to fertilize them in a lab. They then place one or more embryos in your uterus. You also get hormone shots to improve the health of your uterus and boost your odds of a successful pregnancy.
The most common complication of fertility treatment is conceiving more than one child (multiple pregnancy). Fertility medications may also cause ovarian hyperstimulation syndrome (OHSS), which causes your ovaries to swell and hurt.
Donor Eggs and Embryos
If your ovaries don’t produce healthy eggs but your uterus is healthy enough for pregnancy, you may decide to use a donor egg or embryo.
Egg donation. Egg donors may be family members, friends, or strangers, paid or unpaid. You can also buy eggs from an egg bank. Reputable agencies screen all donors for medical, genetic, and mental health issues. Donor eggs are fertilized with sperm from your partner or another donor through IVF. A doctor then places one or more embryos in your uterus. You take hormones to improve the chances of a successful outcome.
Embryo donation (or embryo adoption). People who went through fertility treatment often donate unused embryos for use by others. You can experience pregnancy by having a donated embryo placed in your womb, though the child won’t share your genes. As with egg donation, you’ll need to take hormone drugs.
Other Ways to Start or Grow Your Family
If you aren’t able to or choose not to become pregnant, you can start or grow your family with outside help. You might consider this path if your uterus can’t carry a pregnancy, or if it’s unsafe for you to get pregnant or give birth. Options include:
Traditional surrogacy. The surrogate’s own eggs and the sperm of an intended parent are used to get the surrogate pregnant via artificial insemination. The surrogate then carries the child to term. The child shares the genes of one parent and the surrogate.
Gestational surrogacy (or gestational carrier). This type of surrogacy uses an embryo created from the egg and sperm of the potential parents or from donors. The surrogate goes through IVF, then carries the fertilized embryo to delivery. The child will not share the genes of the carrier.
Laws around surrogacy vary from state to state. You’ll need a lawyer to help you navigate them. The process is costly and can be both legally and emotionally complicated.
Adoption. Most adoption agencies allow cancer survivors to adopt. But you may need a doctor’s letter confirming you’re in good health. Agencies may also consider how much time has passed since your cancer treatment. You might look for an agency with experience working with cancer survivors. The adoption process often takes several years.