Treatment
Fertility choices and ovarian cancer
Being diagnosed with ovarian cancer within childbearing years can have a devastating effect on a woman's choices and aspirations with regards to fertility. In some cases loss of fertility is a consequence of the cancer and its treatment, a situation, which many women find to be a double blow.
This article has been written to help you understand the choices that may be available to you and the responsibilities of the multi-professional team who may be involved in your care. Although it may not answer all of your questions, I hope it provides some useful information on available treatment options whilst understanding some of your feelings which result from a potential or actual loss of fertility.
Catherine Spencer (Clinical Nurse Specialist in Gynaecological Oncology at St. Bartholomew's Hospital, London)
A multi-professional team at the Cancer Centre has the specialist expertise to ensure that you receive the best care. You should receive effective, adequate information and support to enable you to explore the options and the feelings you may have as a result of your diagnosis and treatment. There will be further articles discussing your choices in more detail, outlining the practicalities and highlighting real life experiences.
Firstly, it is important that the medical team gains an understanding of your hopes and concerns regarding having children. For women of childbearing years it would be standard practice to raise this issue. You should be given the opportunity to discuss fertility-sparing options with your surgeon, on the basis of early investigations or suspicion of disease. This is mostly a possibility in some early stages of cancer. In all cases this needs to be weighed up against treating cancer to the best of current ability.
For women with later stage disease of the ovary, it may be useful to explore treatment options with a fertility specialist whilst the plans for your surgery are in progress. Your cancer centre will be able to refer you.
Some of our patients say that they need to have explored every possible avenue before proceeding with any cancer treatment that has an irreversible effect on their fertility. In some situations, the answers may be difficult to come to terms with.
The effects of cancer and its treatment (usually surgery and chemotherapy) on fertility and sexual function may differ, and therefore you should be given the opportunity to make your views and personal priorities clear to the team, who will then take these into account when planning your care.
You should be offered specific information on your cancer and your individual treatment and the impact of these, on your fertility to the best of current knowledge. Information should be both verbal and written and be offered alongside support and counselling with regards to the implications of these, for you and your future hopes.
The following information outlines possible surgery for ovarian cancer, its impact on fertility and the choices that could be discussed. One of these is living childless and being supported with your feelings of loss. Fertility specialists will ask your referring doctor about the safety and possible effects of any drugs. In all cases the welfare of the unborn child, particularly with women with a history of cancer is taken into consideration and will be discussed with you.
SURGERY AND ITS IMPACT ON FERTILITY
Unilateral oopherectomy - the removal of one ovary, leaving the other ovary and uterus. In this case fertility should not be compromised unless there is a previous history of infertility and you should be able to conceive naturally. If you are at all concerned please discuss this with your medical team as in some circumstances, e.g. if you are over the age of 37, it may be worth speaking to a fertility team earlier. Any couple who have been trying for a year to become pregnant could be referred for specialist support. Fertility advice may be required for reasons other than the cancer or its treatment.
Bilateral oopherectomy - removal of both ovaries but retaining the uterus. It is not possible or safe to stimulate the ovaries prior to surgery to harvest eggs when there is suspected cancer in both ovaries. In this difficult situation, the option that may be open to you is of an egg being obtained from an anonymous or known donor (egg donation), fertilised with your partners' sperm and the embryo implanted into your womb. You would need to take hormone replacement therapy to stimulate the lining of the womb to receive the embryo.
Your health will be taken into consideration as well as the length of time since diagnosis and completion of treatment. Legal guidance from the Human Fertilisation and Embryology Authority states that the donor can be up to the age of 35. There is no stipulated age for you in receiving the embryo, but most fertility units have an upper age limit.
Total abdominal hysterectomy and bilateral oopherectomy. This involves removal of the womb, tubes and ovaries, which will result in immediate loss of fertility and hormone function. This is done to remove as much of the bulk of the cancer as possible. This is often extremely difficult and women often describe their feelings of sadness and loss after such an operation.
Support from family, friends and the oncology team is essential in understanding these feelings and allowing you time to absorb what has happened to you. For some, formal counselling has helped. At a time in the future it may be that you wish to consider other options for having a family including surrogacy, fostering and adoption.
Further information on these points can be obtained from:
Childlessness Overcome Through Surrogacy (COTS) www.surrogacy.org.uk
Secretary: Gena Dodd, Loandhu Cottage, Gruids, Lairg, Sutherland IV27 4E7
Local social services will have information regarding fostering and adoption agencies. In all cases your wellbeing and health will be considered alongside that of your partner and the needs of the child. An initial conversation about the impact of cancer treatment on your fertility with your oncology team could lead to onward referral to a fertility specialist for further information in exploring choices. You should be given sufficient time to reflect and the opportunity to discuss treatment options before making an 'informed' decision. The team is ultimately responsible in helping you understand your choices by providing you with adequate information, support and advice throughout.
