Fertility options before cancer treatment

There are fertility options available to you before you start treatment. It is possible for some people to have a healthy child after choosing any of these fertility options before treatment.

The most common fertility options available to you before treatment in Canada include:

Wait and see (no fertility preservation used)
Embryo cryopreservation (embryo freezing). An embryo is made when an egg is combined with sperm.
Oocyte cryopreservation (egg freezing)
Ovarian suppression (temporarily shutting off ovarian function)

Less common and experimental fertility options that may be available to you before treatment include:

Ovarian tissue banking (removing and freezing tissue from your ovary)
In vitro maturation (removing immature eggs from your ovaries)

Click here to learn more about the less common and experimental fertility options.

Please note: the fertility options presented may not be right for everyone. It is important to talk with your healthcare team to decide which of these options might be safe for you.

Questions about the most common fertility options
Frequently Asked Questions	Wait & See	Embryo freezing	Egg freezing	Ovarian suppression
What does the fertility option involve?	1. You start treatment without taking any steps to preserve your fertility	Before treatment: You self-inject hormones every day for 10 to 11 days so your eggs mature. You can also discuss the option to not use hormones. Eggs are collected using an ultrasound-guided needle that is inserted into your vagina Eggs are fertilized with sperm to create embryos Embryos are frozen while you have treatment After treatment: You can thaw the embryos and put them into your womb or into a surrogate This process is called in vitro fertilization and embryo transfer.	Before treatment: You self-inject hormones each day for 10 to 11 days so your eggs mature. You can also discuss the option to not use hormones. Eggs are collected using an ultrasound-guided needle that is inserted into your vagina Eggs are frozen while you have treatment After treatment: You can thaw your eggs and fertilize them with sperm from your partner or a donor to create embryos Embryos are put into your womb or into a surrogate This process is called egg freezing, in vitro fertilization and embryo transfer.	Before treatment: 7 days before your chemotherapy, you are given an injection of medication to temporarily shut down your ovaries and prevent your body from making mature eggs or estrogen For example, leuprolide (Lupron^®) and goserelin (Zoladex^®) are ovarian suppression medications The injection is repeated every 1 to 3 months The monthly injections may stop after you are done chemotherapy Your doctor may advise you to keep taking ovarian suppression with hormone therapy. This is because it can also be used to help reduce the chances of your cancer returning.
Where is this option available?	Available to everyone	All fertility clinics	Most fertility clinics	All oncologists can give you these drugs. However, not all oncologists believe that it will work to protect your eggs.
Will my treatment be delayed?	No delay	Possibly - Takes 2 to 4 weeks. It may take longer for some people.	Possibly - Takes 2 to 4 weeks. It may take longer for some people.	No delay
What is the average cost to me?	No cost	$0 to $20,000	$0 to $15,000	$0 to $500 every month
Is there funding available?	Not applicable	Possibly – funding may be available. Some provinces cover the costs of embryo and egg freezing. Learn about available funding by province on our Cost of fertility preservation page. Fertile Future may give you up to $2500 through the Power of Hope program www.fertilefuture.ca. Your drug insurance plan may cover the cost of drugs. Compassionate medication programs are also available www.infertilitynetwork.org/insurance
What is my chance of getting pregnant? Your chance of having a child by your age are detailed below	Depends on: your age when you try to get pregnant number of eggs left in your ovaries after treatment	Depends on: your age when eggs collected number and quality of eggs collected number of embryos created, frozen, and thawed	Depends on: your age when eggs collected number and quality of eggs collected number of eggs that were successfully thawed number of embryos created Freezing eggs has a lower chance of pregnancy than freezing embryos	Depends on: your age when you start treatment number and quality of eggs that remain in your ovaries after treatment We do not know for sure that this works.
What are my risks?	Your treatment may decrease the number of eggs in your ovaries. You may be unable to have a natural pregnancy after treatment.	You may be at an increased risk of: pain, vaginal bleeding or infection after egg collection Increased estrogen levels from the hormones used to mature your eggs for collection. You will be given an aromatase inhibitor to prevent the rise in estrogen. ovarian hyperstimulation syndrome (painful and swollen ovaries)– mild in 10 out of 100 people and severe in less than 1 out of 100 people. Symptoms vary for each person but may include stomach pain, nausea, vomiting, diarrhea, and sudden weight gain. Ask your fertility specialist about your specific risks.		You may have menopause symptoms and reversible thinning of bones.
What other factors should I consider?	You may decide to wait and see if you do not have time or money to complete another fertility option or as a personal preference. Choosing another fertility option may be stressful. Consider which decision has the most impact on future "you". You may have to wait for several years after treatment before trying to get pregnant.	Sperm is needed to create embryos. You can get sperm from your partner and/or donor sperm. Donor sperm is available within 48 hours from a sperm bank. Counselling may be advised if you decide to use donor sperm. If you choose to freeze embryos with a stable partner/relationship, you both must agree to the future use. This means that if the relationship ends, you have lost your reproductive freedom. You alone cannot make the decision about what do with the embryos. You may face religious or ethical challenges if you do not need the embryos after treatment. Maximum storage time for your frozen embryos may vary by clinic.	You do not need sperm at the time of egg collection or freezing. You can freeze some eggs and some embryos at the same time if you have access to sperm. Maximum storage time for your frozen eggs may vary by clinic. You maintain your reproductive freedom. You alone have the right to make decisions about what to do with your frozen eggs.	You may decide to have ovarian suppression if you do not have time to complete another fertility option or as a personal preference. Your periods will stop when you are using ovarian suppression. You can combine this approach with embryo or egg freezing.

What is my chance of having a pregnancy with the fertility options?

It is important to remember:

chemotherapy reduces your ability to become pregnant and we do not know by how much exactly. It will be different for each person.
your age when you plan to get pregnant will affect whether you have a successful natural pregnancy after treatment
your age when you freeze eggs or embryos will affect whether you have a successful pregnancy using the frozen eggs or embryos
even if your periods come back after chemotherapy, it does not always mean that you will be able to have a natural pregnancy

Read the information below and then find your age range chart for more information.

Wait and see: The chance of having a natural pregnancy after treatment is based on your age and, to some extent, the type of chemotherapy that you get. Even if you do not get chemotherapy, your natural fertility decreases as you age and your chance of having a miscarriage increases.

Embryo freezing

The pregnancy rates for embryo freezing are averages from 34 fertility clinics across Canada in 2015. These averages include people who froze embryos at these clinics during the course of treatment for infertility.

How many embryos will survive the thawing process? The number of eggs collected varies. The collected eggs will be fertilized with sperm. But not all eggs will successfully fertilize to create embryos. All embryos that are successfully created will be frozen. Approximately 90% of frozen embryos will survive the thawing process. The success of a frozen thawed embryo creating a pregnancy is dependent on the age of the person who produced the egg that made the embryo.

Egg freezing

As this is a newer procedure there are no data on the pregnancy rates from fertility clinics in Canada. Pregnancy rates vary for each fertility clinic and you should discuss them with your fertility specialist.

How many eggs will survive the thawing process? The number of eggs collected varies. The collected eggs will be frozen. Approximately 80-90% of frozen eggs will survive the thawing process. The eggs that survive will be fertilized with sperm. But not all eggs will successfully fertilize to create embryos.

Are my chances of getting pregnant lower when I freeze eggs compared to embryos? If your eggs are thawed and fertilized to create healthy embryos then your chances of getting pregnant are the same as if you decided to freeze embryos. However as some eggs may not survive the thaw process, you may have fewer embryos created from frozen eggs than you may from fresh eggs.

You can use an online tool to estimate the chance of having a child after freezing your eggs. This calculator takes your age into account. Online tool: www.fertilitypreservation.org/contents/probability-calculator

Ovarian suppression

We do not know for sure that ovarian suppression can protect eggs. Some studies show promising results for ovarian suppression preventing premature menopause after chemotherapy for breast cancer. However, it is not clear if it improves your chances of having a child after treatment. More research is being done to see if ovarian suppression can protect eggs during chemotherapy.

Please note: The success rates are based on people with and without cancer. We have limited information about fertility success rates for breast cancer survivors. Your chance of success depends on your individual situation. Talk with your healthcare team to understand your specific chances.

What are my chances of getting pregnant with the fertility options?

Wait and See

What are my chances of pregnancy if I choose to wait and see before chemotherapy?

The table below shows your chances of getting pregnant by age range if you decide to wait and see. **NOTE: Not all pregnancies will result in a live birth.**
Age range when you try to get pregnant after treatment	Risk of chemotherapy affecting your fertility	Chance of having a natural pregnancy in one year
Under age 30 when you try to get pregnant	LOW	Approximately 7 out of 10 people (70%) will have a natural pregnancy in one year
30 to 34 years of age when you try to get pregnant	LOW to MEDIUM	Approximately 4 out of 10 people (40%) will have a natural pregnancy in one year
35 to 39 years of age when you try to get pregnant	MEDIUM	Approximately 3 out of 10 people (30%) will have a natural pregnancy in one year
40 to 44 years of age when you try to get pregnant	HIGH	Your chances of having a natural pregnancy are very low. They are less than 10%
Over age 44 when you try to get pregnant	VERY HIGH	Your chances of having a natural pregnancy are very low. They are less than 1%

Please note: A successful pregnancy will depend more on your age when you try to get pregnant after treatment. Talk with your doctor to see how long your treatment will last and when you can safely try and get pregnant.

Embryo Freezing

What are my chances of pregnancy if I choose to freeze embryos before chemotherapy?

Your chance of having a pregnancy with embryo freezing is on top of any natural ability you may have to get pregnant after chemotherapy

The table below shows your chances of having a pregnancy by age range if you decide to freeze embryos. Remember that the chance of having a pregnancy in the general population under the age of 35 is only around 20% to 30% each month. **NOTE: Not all pregnancies will result in a live birth.**
Age range when you freeze your embryos	Chance of having a pregnancy each time embryos are put into the womb
Under age 30 when you freeze embryos	Approximately 5 out of 10 people (50%) will have a pregnancy each time embryos are put into the womb
30 to 34 years of age when you freeze embryos	Approximately 4 out of 10 people (40%) will have a pregnancy each time embryos are put into the womb
35 to 39 years of age when you freeze embryos	Approximately 3 out of 10 people (30%) will have a pregnancy each time embryos are put into the womb
40 to 44 years of age when you freeze embryos	Approximately 1 out of 10 people (10%) will have a pregnancy each time embryos are put into the womb
Over age 44 when you freeze embryos	Your chances of having a pregnancy using your own eggs are very low. They are less than 2%

There are increased risks for any person who gets pregnant and has a child at an older age. Visit the Society of Obstetricians and Gynecologists in Canada for more information on the risks.

Please note: A successful pregnancy will depend more on the age when your embryos were frozen before treatment.

Ovarian Suppression

What are my chances of my period coming back if I choose ovarian suppression before chemotherapy?

There is not enough research completed on ovarian suppression to separate it out by age. The chart below shows the chances of your period coming back after using ovarian suppression compared to those who did not use ovarian suppression.
Fertility Option	Age range when you start chemotherapy	Chance of your period coming back after chemotherapy
No ovarian suppression	Most people between 35 to 40 years of age	Approximately 7 out of 10 people (70%) got their periods back after chemotherapy
Ovarian suppression	Most people between 35 to 40 years of age	Approximately 8 out of 10 people (80%) got their periods back after chemotherapy

Please note: We do not know how much ovarian suppression improves your chances of getting pregnant after treatment. We only know the chance of your period coming back after treatment. But your period coming back after treatment does not always mean you will be able to get pregnant.

FAQs

Do I have enough time to act on any fertility options before my cancer treatment?

It is important to talk to your family doctor, surgeon, oncologist or another member of your healthcare team about fertility as soon as you can. You can get a referral for a fertility specialist or you can self-refer to some clinics in Canada to learn about your options. If you decide to have embryo or egg freezing, it will take some time to set up.

It is common to feel the need to start treatment as soon as possible. However, a short delay to preserve your fertility is unlikely to affect the chance of curing your cancer.

Does the hormone status of my cancer affect the fertility options available to me?: The hormone status of your breast cancer does not affect the fertility option you can choose.

Where can I find a fertility clinic near me?: Ask your family doctor, surgeon, oncologist or another member of your healthcare team if they have a specific fertility clinic where they can refer you. A list of fertility clinics in Canada that are set up to care for young people with cancer is also available at the Cancer Knowledge Network.