Table 2.
Summary of Fertility Preservation Options in Females
| Intervention | Definition | Comment | Considerations* |
|---|---|---|---|
| Embryo cryopreservation (S) | Harvesting eggs, IVF and freezing of embryos for later implantation | The most established technique for fertility preservation in women | Requires 10–14 days of ovarian stimulation from the beginning of menstrual cycle Outpatient surgical procedure Requires partner or donor sperm Approximately $8,000 per cycle, $350/year storage fees |
| Oocyte cryopreservation (I) | Harvesting and freezing of unfertilized eggs | Small case series and case reports; as of 2005, 120 live births reported, approximately 1.6% live births per frozen oocyte (3-4 times lower than standard IVF) | Requires 10–14 days of ovarian stimulation from the beginning of menstrual cycle Outpatient surgical procedure Approximately $8,000 per cycle, $350/year storage fees |
| Ovarian cryopreservation and transplantation (I) | Freezing of ovarian tissue and reimplantation after cancer treatment | Case reports; as of 2005, 2 live births reported | Not suitable when risk of ovarian involvement is high Same day outpatient surgical procedure |
| Gonadal shielding during radiation therapy (S) | Use of shielding to reduce the dose of radiation delivered to the reproductive organs | Case series | Possible only with selected radiation fields and anatomy Expertise is required to ensure shielding does not increase dose delivered to the reproductive organs |
| Ovarian transposition (oophoropexy; S) | Surgical repositioning of ovaries away from the radiation field | Large cohort studies and case series suggest approximately 50% chance of success due to altered ovarian blood flow and scattered radiation | Same day outpatient surgical procedure Transposition should be performed just before radiation therapy to prevent return of ovaries to former position May need repositioning or IVF to conceive |
| Trachelectomy (S) | Surgical removal of the cervix while preserving the uterus | Large case series and case reports | Inpatient surgical procedure Limited to early stage cervical cancer; no evidence of higher cancer relapse rate in appropriate candidates Expertise may not be widely available |
| Other conservative gynecologic surgery (S/I) | Minimization of normal tissue resection | Large case series and case reports | Expertise may not be widely available |
| Ovarian suppression with GnRH analogs or antagonists (I) | Use of hormonal therapies to protect ovarian tissue during chemotherapy or radiation therapy | Small randomized studies and case series; larger randomized trials in progress | Medication given before and during treatment with chemotherapy Approximately $500/month |
Abbreviations: S, standard; IVF, in vitro fertilization; I, investigational; GnRH, gonadotropin-releasing hormone.
*
Costs are estimates.