Treating Ovarian Cancer, Preserving Fertility

Treatment for ovarian cancer usually involves both surgery and chemotherapy. In most cases, the surgery is extensive, and involves removing the ovaries, uterus, and fallopian tubes. Women should discuss fertility-sparing options with their cancer specialists before treatment. If surgery this extensive is medically necessary, "women can decide before their surgery to freeze their eggs so that they can have a baby later on," says Dehn.

In some cases there may not be time to wait for an egg to ripen naturally, or it’s not considered safe to give women the hormones to ripen many egg follicles at once. In these cases, a woman may opt to try a more experimental procedure in which a portion of an ovary, containing many egg follicles, is removed during surgery and then frozen. Later, the eggs contained in that section of ovary can be ripened and fertilized for implantation.

One particularly promising option for a woman is for her eggs to be fertilized with a partner'sor a donor'ssperm. The resulting embryos are then frozen and can be implanted once the time is right for parenthood. Frozen embryos are more likely to result in successful pregnancies than frozen eggs. (But don’t get too concerned with the current success rates for these procedures, because they have been improving, and by the time you’re ready to use your frozen eggs or tissues they could be even better.)

Depending on the stage and extent of a woman's cancer, it may not be necessary to have both ovaries removed. If only one is surgically removed, the goal is for the other ovary to remain intact, and continue producing hormones and ripening eggs. In this case, the woman could be able to become pregnant after treatment ends.

Dehn has seen firsthand that these fertility-preserving techniques can work. "I've had a couple of patients with ovarian cancer who only had one ovary removed and were able to go on and have their own biological child," she says. "I've even had a patient who had one ovary left but had been told she would never be able to get pregnant on her own, who wound up with a surprise pregnancy! So I tell women not to give up hope. If you're under 40, talk to your doctor about egg freezingcalled cryopreservation."

Some chemotherapy drugs used to treat ovarian cancer–including carboplatin and cisplatin–have been linked with impaired fertility. But you can discuss the likelihood of damage with your gynecologic oncologist, and see if there are alternatives that would be equally effective. Dehn recalls another patient whose ovarian cancer was discovered while she was pregnant. "She decided to continue her pregnancy," she recalls. "She started chemotherapy in her third trimester. Her baby was born perfectly fine and healthy."

There are many fertility-sparing treatment options for women to consider if they’ve been diagnosed with ovarian cancer before they’ve become parents or completed their families. Your gynecologic oncologist in consultation with a reproductive endocrinologist can recommend the most effective treatment for your cancer that will also allow you a chance at natural parenthood when your treatment is complete.

 

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