While ovarian cancer is often considered a disease of older age, a significant number of cases affect women during their reproductive years. For younger women diagnosed with ovarian cancer, especially those with germ cell or early-stage epithelial subtypes, the ability to have children is a primary concern. Whether future parenthood is possible depends highly on the disease stage, the specific tumor type, and the required treatment plan for long-term survival. The field of oncofertility has developed specialized approaches to maximize the chances of having a family while still delivering effective cancer care.
How Ovarian Cancer and Treatment Affect Fertility
Fertility is compromised through two primary mechanisms: the physical removal of reproductive organs and the toxic effects of systemic therapies. Standard treatment for ovarian cancer often involves cytoreductive surgery. This surgery may require the removal of both ovaries, the fallopian tubes, and the uterus (hysterectomy), which immediately ends the possibility of natural conception.
Even if reproductive organs are retained, chemotherapy and radiation therapy can damage the remaining ovarian tissue. Chemotherapy drugs, particularly platinum-based agents, are gonadotoxic, meaning they destroy the primordial follicles that house the egg supply. This destruction can lead to diminished ovarian reserve or, in severe cases, premature ovarian failure (POF). POF results in early menopause and permanent infertility due to the depletion of viable eggs.
The degree of damage relates directly to the patient’s age, the specific drug regimen, and the total cumulative dose administered. Younger women treated with lower doses may have a greater chance of recovering ovarian function temporarily. Treatment can also cause scarring and adhesions in the pelvic area. This damage potentially blocks the fallopian tubes or damages the uterine lining, complicating natural conception and successful embryo implantation.
Fertility Preservation Before Treatment
Proactively safeguarding reproductive potential involves a rapid consultation with an oncofertility specialist before cancer treatment begins. The most established method for fertility preservation is the cryopreservation, or freezing, of eggs or embryos. Egg freezing is an option for single women, while embryo freezing is typically chosen by women with partners.
Both procedures require controlled ovarian hyperstimulation (COH), a time-sensitive process using hormone injections to stimulate the ovaries to produce multiple eggs. This process usually takes about two weeks. Modifications, such as using aromatase inhibitors, can make COH safer for women with hormone-sensitive cancers.
Ovarian Tissue Cryopreservation (OTC)
In situations where there is no time for COH, or for prepubescent patients, ovarian tissue cryopreservation (OTC) may be considered. This experimental technique involves surgically removing and freezing a piece of ovarian cortex. Its use in ovarian cancer is approached cautiously due to the theoretical risk of reintroducing cancer cells upon future transplantation.
Fertility-Sparing Treatment Options
For carefully selected patients, the surgical approach can be modified to preserve fertility without compromising oncologic safety. Fertility-sparing surgery is generally considered for women with early-stage disease, such as Stage IA Grade 1 epithelial ovarian cancer or malignant germ cell tumors. The surgery typically involves a unilateral salpingo-oophorectomy, removing only the affected ovary and fallopian tube.
The uterus and the healthy contralateral ovary are left intact during this procedure, allowing for future pregnancy. To ensure the cancer has not spread, the surgeon performs a comprehensive staging procedure. This includes peritoneal biopsies, a careful omentectomy, and pelvic lymph node dissection. Meticulous staging confirms the disease is confined to the removed ovary, ensuring the patient remains eligible for the conservative approach.
Neoadjuvant chemotherapy (chemotherapy given before surgery) may be used in some cases to shrink a tumor and make a fertility-sparing operation possible. The preservation of the uterus is paramount, as it allows the patient to carry a pregnancy, even if both ovaries must eventually be removed. This strategy allows the patient to use the remaining ovary for natural conception or utilize preserved eggs or embryos.
Paths to Parenthood Post-Treatment
Once cancer treatment is successfully completed and the patient is in remission, various routes to parenthood are available depending on the preserved reproductive organs. If the uterus and at least one functional ovary were retained, the woman may attempt natural conception. Oncologists typically recommend waiting one to two years post-treatment before trying to conceive to allow the body to recover and monitor for recurrence.
For women who successfully cryopreserved eggs or embryos prior to treatment, in vitro fertilization (IVF) is the primary path to a biological child. The preserved gametes are thawed, fertilized if necessary, and transferred into the uterus. This method is used when natural fertility has been permanently compromised by chemotherapy or radiation, but the uterus remains healthy.
If both ovaries and the uterus were removed during cancer surgery, biological parenthood is still possible through third-party reproduction. Options include using donor eggs combined with the partner’s sperm, followed by transfer to a gestational carrier (surrogate). They may also choose to use donor embryos or pursue adoption.