Fertility options for women after treatment

Natural pregnancy

If you’re a woman who has completed cancer treatment, your body may recover naturally and produce mature eggs that can be fertilized. The medical team may recommend waiting anywhere from 6 months to 5 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 to 5 years after treatment. The length of time may depend on the type of cancer and the treatment you had.

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. Menopause may start 5 to 20 years earlier than expected. Women older than 35 might need a clear reason for how long they should wait to try to conceive. It’s best for them to talk to their doctors about this before going on with a pregnancy plan.

Donor eggs

Donated eggs come from women who have volunteered 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. These screenings are 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 need to understand what the donor’s relationship with the child will be, and that the donor was 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 carefully timing preparation of the lining of the uterus (using hormone stimulation) to coordinate with the growth of the donor’s eggs. If the woman preparing to receive donor eggs has ovarian failure (she’s 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 then transferred to the recipient to produce pregnancy. After the transfer, the woman will continue to have hormone support until the placenta develops and can produce its own hormones.

Egg donation is the most successful treatment for infertility in women who can no longer produce healthy eggs. The entire process of donating eggs, implanting them and fertilizing them with sperm usually takes 6 to 8 weeks per cycle. The major health risk for cancer survivors and 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 should include the price of IVF plus any payment to the egg donor, but it’s good to find out all the costs beforehand.

Embryo donation

This approach 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 free, 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 hormone 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’s no published research on the success rates of embryo donation, so it’s important that you research the IVF success rates of the centers where you live. Frozen embryo transfers average about a 19% live birth rate, compared with about a 30% live birth rate with fresh embryos. Some centers have higher live birth rates, like 34% with frozen and 51% with fresh embryos, but that’s when the embryo is transplanted into surrogate carriers—who may be healthier and younger than many cancer survivors.

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 egg and sperm 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 artificial insemination. Surrogacy can be a legally complicated and expensive process. Surrogacy laws vary, so it’s important to have an attorney 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’s also very important that the surrogate mother be evaluated and supported 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

For anyone who wants to become a parent, adoption is usually a feasible option. 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 cancer-free and can expect a healthy lifespan and a good quality of life. Some agencies or countries require a period of being off treatment and cancer-free before a cancer survivor can apply for adoption. Five years seems to be an average length of time.

There’s 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 adopting. These classes can help you understand the adoption process and give you a chance to meet other couples in similar situations. The process takes different lengths of time depending on 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 of adopting a newborn vary greatly, from less than $5,000 (for a public agency, foster care, or special needs adoption) up to $50,000 (for some international adoptions, 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 can do so.