When should I discuss fertility preservation with my doctor?
Treatment for ovarian cancer can reduce fertility, limiting your ability to have children in the future. So even though you may feel overwhelmed right after a diagnosis, with information concerning next steps, it is important to have the discussion about fertility before your treatment starts because your options will significantly decrease afterwards. You may not have been thinking about having kids soon and your diagnosis may speed up a lot of those conversations and decisions. Bring along your partner or a friend to help understand the options for women at risk of infertility because of their cancer treatment.
How does ovarian cancer treatment impact my fertility?
Certain chemotherapy drugs can cause acute ovarian failure which results in fewer follicles which can lead to infertility. Chemotherapy can damage healthy cells in your reproductive system. Certain drugs can put you at risk for infertility or premature menopause.
Depending on your staging, you and your health care team may decide a salpingo-oophorectomy is the best course of action. This means the ovary and the fallopian tube are removed. You can have a bilateral (both fallopian tubes and ovaries are removed) or a unilateral (one fallopian tube and its corresponding ovary are removed) salpingo-oophorectomy, depending upon your stage of cancer. The removal of your ovaries can greatly reduce your fertility.
How can fertility be preserved?
Fertility preservation takes place during certain phases of the menstrual cycle which is why consulting a doctor as soon as possible is suggested in order to have the best possible outcome when harvesting eggs.
There are several options that can help you preserve your fertility before undergoing treatment for ovarian cancer:
This is a procedure in which eggs are harvested, fertilized through IVF and then the resulting embryos are frozen. At the beginning of their menstrual cycle, patients will receive hormone injections in order to produce a large amount of eggs to be fertilized. Embryo cryopreservation requires a partner that can provide sperm. This procedure is often very costly and can run up to $12,500 per cycle plus fees to store the embryo.*
This procedure is similar to embryo cryopreservation, but only eggs are frozen, which are smaller and more delicate than embryos, making embryo cryopreservation more successful. If you do not have a male partner or donor but want to keep the option of children open, egg freezing could be an option for you. The procedure can run around $12,000 plus storage fees.* Learn more about the egg freezing procedure here.
Shields are placed near your pelvis in this procedure in order to block the pelvic area from any radiation that the body may be receiving.
If radiation is being administered to the pelvic region, this surgery may be used in which the ovaries are repositioned in a way that removes them from the designated path for radiation.
*These numbers represent estimates. The cost of fertility treatment and insurance coverage can vary. It is important to note that not all insurance plans will cover the cost of fertility treatments. Some options may be covered but it will be dependent on the procedure and your insurance coverage. Talk to your insurance company and make sure you fully understand your policy before going ahead with any fertility procedures. For additional help understanding your options, see the Resources section.
Cancer and Pregnancy
While uncommon, a diagnosis of ovarian cancer during pregnancy can happen and is devastating news for any mother-to-be. Approximately 0.1% of pregnant women are diagnosed with a cancer, ovarian cancer being one of the most common. Because of the sensitivity of the fetus, particularly early on in the pregnancy, it is important to discuss your treatment options with your gynecologic oncologist as well as your OB GYN. Including a social worker or therapist can help you and your family understand your needs and work through the options to make a decision best suited for you, your health and your family.
Treatment for ovarian cancer can cause infertility. If you think you might want to have children in the future, even if you have not decided yet, it is a good idea to discuss your options for fertility preservation with your health care team before chemotherapy or surgery.
Your doctor may suggest a complete hysterectomy as part of the best course of action for the type and stage of your cancer. When a complete hysterectomy is done, the entire uterus is removed as well as the ovaries and fallopian tubes. Note: You should talk to your doctor about whether you still need a Pap test after a hysterectomy.
Debulking surgery, performed in order to remove as much of the tumor and cancer cells as possible, may consist of a complete hysterectomy and may also include removal of pieces of some of the surrounding organs.
In addition to infertility, a major side effect of a complete hysterectomy is menopause, defined as twelve months without a period. You may have heard about this as something older women go through. The symptoms of menopause are related to the loss of sex hormones in the body when the reproductive system is removed. Because of the reduction of hormones in your body, you are likely to experience side effects – some long term and some temporary.
Going through menopause and subsequent infertility at a young age can be very disorienting and lead to a lot of questions like “What are these changes happening to my body?” “How will I date in the future?” and “How does this affect my womanhood?” It is important to remember you are not defined by your fertility. Take some time to think about what your body is going through and the impacts this may have, and find support in other survivors or medical professionals to help better understand the changes of menopause.
|Side Effects of Menopause||Tips for Coping|
|Hot flashes – You may go through brief periods throughout the day where you feel uncomfortably warm. Night sweats are also common among women going through menopause.||Exercise and acupuncture are two strategies for dealing with hot flashes. Hot flashes won’t last forever. Also try to layer clothing to easily adjust during a hot flash.|
|Sleeplessness – Inability to fall asleep or stay asleep.||Speak with your doctor about medications that may help you feel more rested at night. Melatonin, a naturally occurring hormone, can be used to combat insomnia.|
|Mood swings – Because of the changes in hormone levels in your body you may experience periods of sadness followed by periods of happiness.||Remember that your body is going through significant changes. Allow yourself permission to feel and understand your feelings. Yoga and exercise as well as personal support can be helpful in navigating mood swings.|
|Trouble concentrating||Different tactics can help you keep focus. Whether it’s removing external distractions or keeping notes on a task, find the strategy that works best for you. Try not to get frustrated and allow yourself some leeway.|
|Vaginal side effects – Vaginal atrophy and dryness can occur while going through menopause.||Lubricants can help to ease the discomfort of vaginal dryness. Hormone Replacement Therapy (HRT) and estrogen replacement has been used in the past to combat side effects of menopause. There are some risks associated with HRT such as increased risk for breast cancer and heart disease. Discuss the risks and benefits with your doctor to see if HRT is the right option for you. Other alternative therapies include exercise and diet, sexual activity to improve blood supply to the area and alternative therapies like acupuncture.|
Vaginal side effects are often glazed over or completely ignored when discussing side effects with your health care team. It is a sensitive topic and can be embarrassing. But it is an important quality-of-life issue you will want to address. If your doctor does not bring it up, do not be shy about introducing the topic. S/he can explain the cause of the side effect and recommend a possible treatment plan.
|Infertility||There are options to deal with infertility including adoption or cryopreservation. See the section on infertility.|
|Sexual Side Effects – Loss of interest in sex or painful sex can arise during menopause.||The changes in your hormone levels along with the emotional stress of cancer and treatment can lessen your interest in sexual activity. This can be incredibly difficult at a time when you are establishing your sexual identity. Communication with a current partner or a professional can help you navigate this sensitive issue. Planning sexual activity with a partner may seem awkward because it will take the spontaneity out of the moment, but it will help you cope with fatigue related to your treatment.|