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:

  1. 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.
  2. Eggs are collected using an ultrasound-guided needle that is inserted into your vagina
  3. Eggs are fertilized with sperm to create embryos
  4. Embryos are frozen while you have treatment

After treatment:

  1. 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:

  1. 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.
  2. Eggs are collected using an ultrasound-guided needle that is inserted into your vagina
  3. Eggs are frozen while you have treatment

After treatment:

  1. You can thaw your eggs and fertilize them with sperm from your partner or a donor to create embryos
  2. Embryos are put into your womb or into a surrogate

This process is called egg freezing, in vitro fertilization and embryo transfer.

Before treatment:

  1. 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

  2. The injection is repeated every 1 to 3 months
  3. 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 that remain in your ovaries

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 your partner gives sperm, you both have to agree to future embryo use.

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 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.

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% 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.

Why 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. But since more frozen eggs do not survive the thawing and fertilizing process, your chances of getting pregnant with egg freezing is lower than with embryo freezing.

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/index.php/probability-calc

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.
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.

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.

Next: Parenthood Options