Oncofertility describes the program where we help patients facing cancer treatment explore options for fertility preservation. University of Kentucky cancer center specialists are available to discuss your options and guide you to resources to help preserve your or your child's ability to have children before undergoing cancer treatment.

Some treatment options are available at UK, while other options are available to patients through UK’s relationships with regional providers. Oncofertility counseling is also available to patients. Counseling is initially offered to all patients from birth up to age 40 as well as anyone with interest.

Before beginning this process, it is important that you understand that each patient has their own risk of infertility based on diagnosis and treatment plan (surgery, chemotherapy, radiation). The guide below can be used to help quantify your risk level based on your condition and treatment.

≥ 80% = High infertility risk

20 - 80% = Moderate infertility risk

≤ 20% = Low infertility risk

Speak with your doctor to discuss your treatment options and determine your personal risk of infertility. You may consider asking the following questions as well:

• How will cancer and treatment affect fertility?
• What fertility preservation options are available?
• How much time do I have to preserve fertility before needing to start treatments?
• After treatments are over, how long will it take for periods to begin again?
• Is pregnancy safe after treatment? If so, when?
• Can you refer me or my child to a reproductive specialist?

There are several options to consider based on age, treatment plan and presence of a partner. In some cases, carrying a pregnancy to term before therapy may also be an option. There are ways to build a family after cancer even if you cannot preserve your fertility now. Talk to your oncologist or a fertility preservation specialist. They can help you decide which option may be right for you.

Treatment options for girls and women include:

• Oocyte (egg) cryopreservation, where eggs are harvested and frozen for future use. For egg cryopreservation to be effective, this option will delay starting cancer treatment by up to 14 days in order to give hormones to prepare eggs for harvesting. Egg cryopreservation has a 4-12% live birth rate per egg.
• Embryo cryopreservation, where eggs are harvested and fertilized with sperm (from partner or donor sperm) to create an embryo, and then these embryos are frozen for future implantation. For embryo cryopreservation to be effective, this option will delay cancer treatment by up to 14 days to give hormones to prepare eggs for harvesting. Embryo cryopreservation has a 35-50% live birth rate per embryo transfer.
• Ovarian transposition, an option that moves the ovaries out of the radiation field to prevent radiation-induced failure.
• Ovarian suppression, an experimental treatment with a medication that modulates hormones to possibly make the eggs more resistant to damage during chemotherapy.
• Ovarian tissue cryopreservation (OTC), a therapeutic procedure that involves removing and freezing ovarian tissue before cancer treatments start. The whole ovary is removed during a surgical procedure, and this ovary is then frozen. The time frame to organize OTC is typically two to three days. Learn more about this treatment option at The Oncofertility Consortium online.
• Donor eggs are used with donor sperm or sperm from your partner to make embryos. Embryos can then be used at the time of fertilization or cryopreserved to use at a later date.
• Surrogacy involves having another woman carry a fetus in your place. This can involve your eggs or sperm, or donor eggs or sperm.
• Adoption is another option for patients who want to build a family after treatment. Visit The Oncofertility Consortium online for a list of cancer-friendly adoption agencies.

Talk with your oncologist or a fertility preservation specialist in order to decide what the best option for you may be. Treatment options for males include:

• Sperm cryopreservation involves collection of a semen sample and then freezing the sperm for use at a later date. Future use of the frozen sperm involves either intrauterine insemination (introducing the thawed sperm into the uterus) or in vitro fertilization (combining an egg and thawed sperm to create an embryo and then transferring this embryo into a uterus). Patients must be able to collect a sample through masturbation for this option. This usually takes one to two days to organize. 
• Testicular tissue cryopreservation (TTC), an experimental procedure where testicular tissue is taken directly from the testicle itself and then frozen to be used at a later date. This is an option for prepubertal males who are not yet producing sperm and for postpubertal males who are unable to produce a specimen through masturbation. This usually takes 2-3 days to organize.
• Donor sperm can be combined with your partner’s egg if you are not able to produce sperm that can be used in the future.
• Adoption is another option for patients who want to build a family after treatment. Visit The Oncofertility Consortium online for a list of cancer friendly adoption agencies.

When the time comes, you will always have the opportunity to discuss options with your oncofertility team. We will help you determine the best options for achieving a pregnancy using your frozen samples.

• How will my cancer and treatment affect my fertility?
• What are my fertility preservation options?
• How much time do I have to preserve my fertility before I need to start my treatments?
• After my treatments are over, how long will it take for my periods to begin again?
• Is pregnancy safe for me after treatment? If so, when?
• Can you refer me to a reproductive specialist?

Procedures to preserve fertility can be costly. Your fertility specialist will work with you to pursue coverage by your insurance carrier when possible prior to any treatment. They may also partner with several organizations to help arrange services at a reduced cost if your insurance carrier does not cover your procedures.

For more information about infertility and preservation options for women with cancer, visit these websites:

• The Oncofertility Consortium
• SaveMyFertility.org
• LiveStrong.org
• Cancer.gov