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Getting a childhood cancer diagnosis can be overwhelming. Since cancer treatment can affect your child’s fertility (the ability to have children) later in life, learning about fertility preservation early on is important.
We know that this can be a stressful time, as you’ll be worrying about your child’s health and learning about treatment, so we have made a list of available fertility preservation options, which are below. Consider talking to your child’s doctor about which option is best.
Understanding the risk of infertility
Some cancer treatments can put your child at risk of infertility. The table below details the risk of infertility with these different treatments:
| High risk |
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| Intermediate risk |
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| Low risk |
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| Very low/no risk |
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| Unknown risk |
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Exploring fertility preservation options
- Girls who have not undergone puberty yet have the option of ovarian tissue banking.
- Girls who have undergone puberty and are able and willing to undergo ovarian stimulation have the option of egg banking.
- Girls who have undergone puberty but are not able and willing to undergo ovarian stimulation have the option of ovarian tissue banking.
Please note that ovarian tissue banking is not option if you or your child have a high risk of ovarian mestastes (cancer spreading). Ovarian tissue banking is experimental and only done as part of clinical study approved by an Institutional Review Board (IRB).
| Ovarian suppression |
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The ovaries are small, oval-shaped glands on either side of the uterus. The job of the ovaries is to produce, store and release eggs for pregnancy. The ovaries also make hormones that control menstruation, or your period. During ovarian suppression, the ovaries’ jobs are temporarily stopped while you are getting cancer treatment. It involves injecting medication every 1-3 months during chemotherapy or radiation therapy. While there is not a lot of data on this method in young patients, ovarian suppression can help with stopping a person’s period during cancer treatment and help the chance of it returning at the end. Side effects of this treatment are close to symptoms of menopause and can include hot flashes and mood swings. These symptoms are less common in young patients, and a doctor can provide guidance and support for managing these side effects if they happen. |
| Egg retrieval and storage |
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This process involves ovarian stimulation to produce many egg follicles (sacs that hold a developing egg) in one cycle. This is done with injectable hormone-based medications. Ultrasound is used to watch the growth of these follicles from the ovaries and pick the right time for egg retrieval. Egg retrieval is done under sedation with the use of an ultrasound-guide needle through the vagina into the egg follicles, allowing multiple eggs to be collected during one retrieval. The collected eggs are then frozen and stored until the patient wants to become pregnant. Generally, each egg retrieval cycle takes about 2-4 weeks and there is about a 5-10 per cent chance of live birth per egg. Side effects from the medications used to stimulate the ovaries include nausea, bloating and mood swings. Eggs can be stored for an unlimited amount of time after collection. |
| Ovarian tissue cryopreservation |
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This process involves the surgical removal of one ovary by a laparoscopy. It involves making 3-5 small stomach incisions and a camera to see the ovarian tissue for removal. This tissue is then frozen and preserved before cancer treatment. When the patient is ready to become pregnant, another surgery is done to transplant the tissue back. Ovarian tissue preservation is suggested for those who have not yet reached puberty or those who cannot undergo ovarian stimulation for egg retrieval. Studies show that this procedure has a success rate of about 30% in achieving a successful pregnancy. The risks associated with this procedure are related to the surgical procedure and undergoing general anesthesia. This process requires a referral to Ste-Justine Children’s Hospital in Montreal. |
For girls undergoing radiation therapy, their option is ovarian transposition and radiation shading.
Cost of fertility preservation
The cost for ovarian tissue cryopreservation at Ste-Justine Hospital is $2500 and is not covered by OHIP.
The cost of medication for egg freezing with the Ottawa Fertility Centre is not covered by OHIP and would need to be covered either by a parent’s insurance or a compassionate access program such as Serono or Fertile Futures.
The cost of storage after egg freezing for the first year is free, and then it is $500 per year.
Menstruation during fertility treatment
Some people stop getting their period during cancer treatment. Alternatively, others have heavy or irregular menstrual bleeding. This can be problematic for those undergoing chemotherapy, as this places them at higher risk of anemia, a condition that should be looked at by a doctor.
If you or your child notice serious changes in the frequency or duration of their menstrual cycle during cancer treatment, follow up with a gynecologist or oncologist. If your child is still having issues after treatment, talk to their doctor.
Sexual health during cancer treatment
It's important if your child is getting cancer treatment to tell their doctor if they’re sexually active. Some cancer treatment medications are teratogenic – meaning they can cause miscarriage or birth defects. It is important to use effective birth control during cancer treatment. There are many different birth control options available, and parents should work with their child and child’s doctor to choose the right one.
Those who are sexually active should also use barrier protection, such as condoms, to prevent sexually transmitted infections, as these can be more dangerous if you’re immunocompromised while getting cancer treatment.