Options for Cis Females and Trans Males
Egg Freezing (oocyte cryopreservation)
Egg freezing allows individuals, both cis women and trans males, who require cancer treatment to freeze their eggs for later use. Cancer therapies such as chemotherapy, radiation, and surgery can impact a patient’s ovarian reserve and, in some cases, can cause premature menopause post treatment. Egg freezing is a way to preserve fertility. The patient will undergo ovarian stimulation, which is started by administering daily injections of FSH and hMG for 9–12 days. When instructed, a trigger shot is given to mature the eggs and 36 hours later a minor surgical procedure, called an egg retrieval, is performed under anesthesia. All mature eggs are frozen and stored for future use.
When the patient is ready for parenthood, the eggs are thawed, fertilized and biopsied for genetic testing (if desired) and transferred to the uterus. The egg freezing process typically lasts two weeks. The patient’s fertility doctor will discuss the proposed treatment and timeline with their oncologist to ensure that the timing is appropriate. Patients should let their cancer care team know that fertility preservation is important to them.
Embryo Freezing
Embryo freezing allows patients to create and freeze embryos for transfer at a later date. Although similar to egg freezing, we have more information about the future success rates with embryos since they are further along in the process, so freezing embryos is typically recommended for those already partnered or who have a sperm donor picked out. Eggs remain the property of the patient and they alone decide what will be done with them in the future. Embryos created with a partner’s sperm mean that both partners have to agree on their disposition (to attempt pregnancy, discard, etc.). Speak to your doctor to see if both egg and embryo freezing is an option for you.
Embryo freezing starts with ovarian stimulation by administering injections daily of FSH and hMG for 9–12 days. When instructed, a trigger shot is given to mature the eggs and 36 hours later a minor surgical procedure, called an egg retrieval, is performed under anesthesia. All mature eggs are fertilized using a semen sample from their significant other or a sperm donor. The embryos are observed in the embryology lab for 5–6 days. Then, viable embryos are biopsied for genetic testing (if desired) and frozen and stored for future use. At a later date, a frozen embryo can be thawed and transferred to the uterus. The patient’s fertility doctor will discuss the proposed treatment and timeline with their oncologist to ensure that the timing is appropriate. Patients should let their cancer care team know that fertility preservation is important to them.
Ovarian Suppression
Ovarian suppression is used when patients cannot or choose not to freeze eggs or embryos. Instead, physicians will focus on protecting the ovaries during treatment. This will stop ovaries from ovulating temporarily, which decreases the blood flow to them and protects the eggs, ultimately minimizing potential chemotherapy damage. Ovaries are suppressed with a GnRH agonist like Leuprolide or Goserelin injections, which are given either monthly or every three months. When recommended, ovarian suppression is often initiated two to four weeks prior to beginning the first chemotherapy treatment and continued throughout the duration of treatment.
Ovarian Shielding
Ovarian shielding is used when patients undergo radiation therapy. A protective cover is placed over the outside of the body during treatment—specifically the ovaries—in order to protect the ovaries and minimize damage from the radiation. This may be covered through medical insurance. Please speak to your PCA about available options.
Ovarian Transposition
Ovarian transposition is a surgical procedure where a patient’s ovaries are repositioned outside of the pelvic radiation treatment field to reduce exposure and minimize damage. This is performed in patients with treatment that includes pelvic radiotherapy for Hodgkin’s disease and other gynecologic malignancies. Ovarian transposition may be covered through medical insurance. Please speak to your PCA about available options.
Ovarian Tissue Freezing
Ovarian tissue freezing is used in some circumstances where patients are unable to undergo ovarian stimulation for egg or embryo freezing, and the only viable option is to surgically remove and preserve ovarian tissue. One whole ovary (or parts of the ovary) are removed. The tissue that contains the eggs is separated from the rest of the ovary, frozen, and stored for future family building. If the patient is no longer fertile after cancer treatment, using this tissue may help the patient have a biological child. It is usually used by female patients who do not have adequate time for egg or embryo freezing and pre-pubertal females who are not able to undergo ovarian stimulation. Ovarian tissue freezing is not covered by the Progyny benefit. Please speak to your PCA about available options.
