Options for women after treatment

As discussed before, women have several options to try to preserve fertility if it is done before cancer treatment (see the section "Preserving fertility in women"). But what if you've already had cancer treatment and didn't freeze embryos or egg tissue? There are some other options that may work for women after their cancer treatment.

Natural pregnancy

If you are a woman who has completed cancer treatment, your body may recover naturally and produce mature eggs that can be fertilized. Your doctor may advise you to wait for some length of time before you try to get pregnant. The length of time could vary depending on the type of cancer and the treatment you had. It is always best to talk to your doctor before going on with a pregnancy plan.

Some oncologists just make a standard recommendation to wait 2 years before trying to get pregnant. This is often based on the fact that many cancers tend to have the highest rates of recurrence (the cancer coming back) in the first 2 years after treatment. But women who have had chemo or radiation to the pelvis are also at risk for sudden, early menopause even after they start having menstrual cycles again. Women over age 35 may want a clear reason for how long they should wait to try to conceive.

Donor eggs

Donated eggs come from women who volunteer to go through a cycle of hormone stimulation and have their eggs collected. In the United States, donors can be known or anonymous. Some couples find their own donors on the Internet or through specialized programs at infertility clinics. Some women have a sister, cousin, or close friend who is willing to donate her eggs without payment.

Egg donors need to be screened carefully for sexually transmitted diseases and genetic illnesses. Every egg donor should also be screened by a mental health professional familiar with the egg donation process. This is just as important for donors who are friends or family members. You want to be sure that everyone agrees about what the child will or will not be told in the future. Everyone also will want to understand what the donor's relationship will be with the child, and that the donor is not pressured emotionally or financially to donate her eggs.

Any woman who has a healthy uterus and can maintain a pregnancy can have IVF with donor eggs and a partner's (or donor's) sperm. The success of the egg donation depends on the careful timing of preparing the lining of the uterus with hormone stimulation to coordinate with the growth of the donor's eggs. If the woman preparing to receive donor eggs has ovarian failure (is in permanent menopause), she must take estrogen and progesterone to prepare her uterus for the donor egg. The eggs are taken from the donor and fertilized with the sperm. Embryos are transferred to the recipient to produce pregnancy. After the transfer, the woman will continue to have hormone support until her placenta develops and can produce its own hormones.

Egg donation is the most successful treatment for infertility. The entire process of donating eggs, implanting them and fertilizing them with sperm usually takes to 6 to 8 weeks per cycle. The major health risk for the cancer survivor or the babies is the risk of having twins or triplets. Responsible programs may transfer only 1 or 2 embryos to reduce this risk, freezing extras for a future cycle. The price of a donor egg cycle includes the price of IVF plus any payment to the egg donor.

Embryo donation

Embryo donation is an approach that allows a couple to experience pregnancy and birth together, but neither parent will have a genetic relationship to the child. Embryo donations usually come from a couple who have used assisted reproductive technology and have extra frozen embryos. When that couple has conceived or for some other reason chooses not to use those frozen embryos, they may decide to donate them. One problem is that the couple may not agree to have the same types of genetic testing as is usually done for egg or sperm donors, and they may not want to supply a detailed health history. On the other hand, the embryos are given without payment to the couple, so the cancer survivor only needs to pay the cost of getting her uterus ready and having the embryo placed.

Any woman who has a healthy uterus and can maintain a pregnancy can have IVF with donor embryos. Most women who try the donor embryo procedure must get hormonal treatments to prepare the lining of her uterus and ensure the best timing of the embryo transfer. The embryo is thawed and transferred to the woman to achieve pregnancy. After the embryo is transferred, the woman continues hormone support until blood work shows that the placenta is working on its own, usually around 8 to 10 weeks.

There is no published research on the success rates of embryo donation, so it is important that you research the IVF success rates of the centers where you live. Frozen embryo transfers average around a 19% live birth rate, compared with around a 30% live birth rate with fresh embryos.

Surrogacy

Surrogacy is an option for women who cannot carry a pregnancy, either because they no longer have a working uterus, or would be at high risk for a health problem if they got pregnant. There are 2 types of surrogate mothers.

A gestational carrier is a healthy female who receives the embryos created from the tissues of the intended parents. The gestational carrier does not contribute her own egg to the embryo and has no genetic relationship to the baby.

A traditional surrogate is usually a woman who becomes pregnant through artificial insemination with the sperm of the man in the couple who will raise the child. She gives her egg, carries the pregnancy and is the genetic mother of the baby.

The success rates for surrogacy are about the same as standard IVF artificial insemination. Surrogacy can be a legally complicated and expensive process. Surrogacy laws vary, so it is important to have an attorney to help you make the legal arrangements with your surrogate. You should consider the laws of the state where the surrogate lives, the state where the child will be born, and the state where you will live. It is also very important that the surrogate mother have evaluation and support by an expert mental health professional as part of the process. Very few surrogacy agreements go sour, but when they do, typically this step was left out.

Adoption

Adoption is a feasible option that can be considered by anyone who wants to become a parent. Adoption can take place within your own country by a public agency or by a private arrangement, or internationally through private agencies. Most adoption agencies state that they do not rule out cancer survivors as potential parents. But agencies often require a letter from your doctor stating that you are free of cancer and can expect a healthy lifespan and a good quality of life. Some agencies or countries require a period of being off treatment and free of cancer before allowing a cancer survivor to apply for adoption. Five years seems to be the average length of time.

There is a lot of paperwork to complete during the adoption process, and at times it can seem overwhelming. Many couples find it helpful to attend adoption or parenting classes before their adoption. These classes can help you understand the adoption process and allow you to meet other couples in similar situations. The adoption process takes a different length of time depending upon the type of adoption you choose. Most adoptions can be completed in 1 to 2 years. There are many agencies (local, national, and international) that can help you adopt a child. Some agencies specialize in placing children with special needs, older children, or siblings. Costs also vary greatly, from about $3,000 (for a public agency, special needs adoption) up to as much as $40,000 (for an international adoption including travel costs).

You may be able to find an agency that has experience working with cancer survivors. Some discrimination clearly does occur both in domestic and international adoption. Yet, most cancer survivors who want to adopt a baby manage to do so.

Options for men after treatment

After treatment, most men recover some ability to produce sperm cells. If the sperm counts and movement (motility) are close to normal, men may be able to father a child through sexual intercourse (natural conception). If only a few sperm are present in the semen, men may need to use infertility treatment methods, such as intrauterine insemination or IVF-ICSI.

Even when men have no sperm in samples of their semen, small areas of sperm production may still exist in the testicle. In this case, a surgeon using a microscope can take several samples of tissue to look for sperm to use in IVF-ICSI. This is called testicular sperm extraction, or TESE for short, and was mentioned earlier (see "Sperm extraction" in the section "Preserving fertility in men").

There are also other options for men who need help with fertility after cancer treatment. They are listed here.

For loss of the prostate and seminal vesicles

If you have had prostate or bladder cancer, surgery was probably done to remove your prostate gland and the seminal vesicles (the organs that produce most of the fluid for semen). This means that your body no longer makes semen. Also, the ends of the vas deferens (small tubes running from each testicle to the prostate) are generally cut during this type of cancer surgery, like they are for a vasectomy, so there is no way for the sperm to get outside your body. With enough mental or physical sexual excitement, you should still be able to have the pleasurable feeling of orgasm (climax), but it will be a "dry" orgasm.

If there is no semen coming from the penis during orgasm, conceiving a child during sex is not an option. But there are ways that sperm can be taken out and used to fertilize an egg. An infertility specialist can take sperm from the epididymis (the tiny tubes where sperm cells ripen at the top of the testicles) or use TESE, as described above.

For dry orgasm because of damage to nerves during cancer treatment

Some men have dry orgasm after surgery for colon cancer or after removal of lymph nodes as part of treatment for testicular cancer. But if you still have your prostate and seminal vesicles, several treatments may work. For some men in this situation, the prostate and seminal vesicles are completely paralyzed. They normally squeeze and relax rhythmically as a man's climax begins, but nerve damage can keep this from happening.

If nerve damage is mild, the prostate and seminal vesicles may still work normally. Often, though, the valve that is supposed to block semen from getting into the bladder doesn't close the way it should. If this valve stays open, semen shoots backward into the bladder instead of out through the penis during a man's climax. This is called retrograde ejaculation. When the problem is just retrograde ejaculation, there are medicines that can be taken for it. If the medicine works, normal ejaculation of semen is restored. The seminal vesicles contract, the internal valve at the bladder entrance closes, and semen is ejaculated from the penis at orgasm. In the United States, the most common medicine used to restore emission is ephedrine sulfate. Because it does not help everyone and may only work for a few doses, ephedrine sulfate is usually prescribed only for the fertile week of the woman's cycle.

Another option for retrograde ejaculation is that live sperm cells can be taken from urine a man produces just after a climax. The man is given medicine to make his urine less acidic, causing less damage to his sperm. Usually the man is asked to use self-stimulation to reach orgasm at the urology clinic. His urine is collected just after orgasm, either through urination or catheterization. The sperm cells are separated and put in a sterile solution to use in infertility treatment.

If none of these options work, another choice is to put a man under anesthesia (drugs are used to put him into a deep sleep) and a special electrical probe is used in the anal canal to trigger an ejaculation of semen through the penis. Since this procedure, called electro-ejaculation, can cause scar tissue to form, it is not used often. It must be done with a special machine that is only available in some infertility clinics.

For men who produce no sperm

Using donor sperm (donor insemination) is the most simple and least expensive way to become a parent for men who are infertile after cancer treatment. Major sperm banks in the United States collect sperm from young men who go through a detailed screening of their physical health, family health history, educational and emotional history, and even some genetic testing. Sperm donors are chosen for their high sperm counts and motility. They are also tested for sexually transmitted diseases, including the human immunodeficiency virus (HIV) that causes AIDS and the hepatitis viruses B and C. Couples may be able to choose a donor who will remain anonymous or one who will be willing to have contact with a child later in life. Anonymous donor sperm usually costs less.

Insemination usually is done in the doctor's office. The purified sperm sample is placed directly into the woman's uterus through a tiny, flexible tube. If needed, the woman's doctor might prescribe hormones to ripen more than one egg, which will increase the chance of a pregnancy. Success rates are good, and most women under age 35 without fertility problems get pregnant in an average of 3 to 6 cycles. The cost of donor sperm varies, but averages about $500 to $600 a cycle, and includes the cost of the insemination. This cost does not include the cost of hormones for the woman. Be sure to ask for a list of all fees and charges before insemination, since these differ from one sperm bank to another.

Adoption

Issues for cancer survivors interested in becoming parents by adoption were discussed previously. They are not really any different from when a man has had cancer. See the section "Adoption" under "Options for women after treatment."

Go back to Fertility and Cancer: What Are My Options?

Last Medical Review: 07/23/2009
Last Revised: 07/23/2009