A woman’s ability to get pregnant decreases as she gets older. Fertility can also suffer when women and men receive certain types of cancer treatment. To help patients protect their ability to have children, the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital hosts a fertility preservation program.
This program gives women the chance to preserve their eggs — or for couples, their embryos — for future use. And it offers fertility preservation for men facing cancer treatment that could impact their ability to father a child.
“Our job is to make sure patients understand their options,” said Mark Donald Hornstein, MD, director of the Brigham’s Reproductive Endocrinology Division. “We want to help them make the right decisions for them.”
Planning for a future family
The Center for Infertility and Reproductive Surgery helps women who are not ready to become mothers when their fertility starts to decline. “We are seeing more women in their early 30s who are single and who want to have families in the future,” said Elizabeth Sarah Ginsburg, MD, medical director of assisted reproductive technologies.
“Unfortunately, many women — and even some doctors — are not aware of the significance of the decline in fertility with age. A common misconception is that you are fertile until menopause. But very few women can get pregnant in their mid-40s and beyond.”Mark Donald Hornstein, MD
Infertility goes up significantly as women get older. Rates jump from under 10 percent for women in their 20s to nearly 30 percent for women in their early 40s. “The older a woman’s eggs are, the lower the likelihood that they will result in a successful pregnancy,” said Dr. Ginsburg.
Infertility risk factors
The risk of developing infertility is also elevated for women with:
- A history of pelvic surgery
- Low levels of AMH, a hormone produced by the ovaries
- Pelvic inflammatory disease
- Polycystic ovary syndrome (PCOS)
- Uterine fibroids
“Unfortunately, many women — and even some doctors — are not aware of the significance of the decline in fertility with age,” Dr. Hornstein said. “A common misconception is that you are fertile until menopause. But very few women can get pregnant in their mid-40s and beyond.”
Preserving fertility in people with cancer
Receiving a cancer diagnosis can be overwhelming for anyone. For cancer patients who wish to have children, it may be especially upsetting if treatment affects their fertility.
Cancer treatment can impact fertility for both women and men. In women, chemotherapy and radiation for some kinds of cancer can cause the ovaries to stop releasing eggs. Treatment may also lead to drops in the hormone estrogen. This can affect fertility and cause early menopause.
Infertility caused by cancer treatment in women may be temporary or permanent. Doctors don’t always know whether a woman’s fertility will return after treatment.
In men, cancer treatment may affect their sperm. “Men undergo fertility preservation primarily in situations in which future fertility may be compromised by chemotherapy or radiation,” Dr. Hornstein said. The Brigham offers men with cancer urgent sperm banking that can allow them to father children in the future.
To give cancer patients the most accurate information about their options, fertility doctors at the Brigham work closely with oncology specialists. “It’s really important that cancer patients are counseled appropriately so they know what to expect,” Dr. Ginsburg said.
Egg freezing, embryo freezing and ovarian tissue replacement
The Brigham Center for Infertility and Reproductive Surgery offers women various ways to preserve their fertility. These options include:
- Egg freezing: A doctor removes eggs from your ovaries, freezes them and stores them for later use. When you’re ready to get pregnant, they thaw your eggs, fertilize them in vitro and transfer the fertilized eggs to your uterus as embryos.
- Embryo freezing: This is similar to freezing eggs. However, the eggs are fertilized by your partner’s sperm or a sperm donor before being frozen and stored.
- Ovarian tissue replacement: This may be recommended for cancer patients who don’t have time to freeze eggs or for girls who have not yet reached puberty. Tissue is removed from the egg-producing portion of your ovary. Then, after your cancer treatment, the tissue is placed back into your body. The replaced ovary tissue typically releases eggs for 3 to 8 years.
Making an informed decision
If you have questions about your fertility, the care team at the Center for Infertility and Reproductive Surgery invites you to make an appointment. “We’re not here to talk you into it or out of it,” Dr. Hornstein said. “But we do want to educate you and empower you to make an informed decision.”