Embryo freezing is considered an established fertility preservation method as it has routinely been used for storing surplus embryos following infertility treatment using IVF. The limitations for use with oncology patients include treatment delay (between two to six weeks), the potential risk of estrogen exposure for those patients with hormone-sensitive tumors, and the need for a male partner or other sperm source.

Once eggs are mature from the medications, doctors will remove them in an outpatient surgical procedure using a light form of anesthesia for about 10-20 minutes. The procedure is done vaginally with an aspirating needle, so there are no incisions or scars from the treatment. Once removed, the eggs will be fertilized in the lab with sperm to create embryos. The embryos that develop successfully will be frozen for future use.

Years of data supports very high cryo-survival rates of embryos frozen at this very early stage. Embryo freezing should be the first option considered provided the patient has a male partner.

Costs of Embryo Cryopreservation: The costs to collect and freeze embryos are in the $10,000-$15,000 range (per cycle) range. Storage fees vary, depending on the storage facility, but are in the $350-$1000 per year range. Shipping fees may also apply. Financial assistance programs exist to help with the costs, such as LIVESTRONG's Sharing Hope program and ReproTech's Verna's Purse program.
 

If possible to arrange, oocyte (egg) freezing provides the patient with the combination of the least invasive procedure and most options in the future. Currently two primary methods of egg freezing exist; the more traditional slow-freezing protocols and the more recently applied vitrification protocols. Both methods have resulted in hundreds of live births worldwide. Since oocyte cryopreservation is still considered an experimental procedure by the American Society for Reproductive Medicine (ASRM), it is generally only offered in a research setting with an Internal Review Board oversight. Oocyte freezing has similar limitations as embryo cryopreservation (treatment delay and potential risk of estrogen exposure for those patients with hormone-sensitive tumors), but there is no sperm source required at the time of freezing.

GnRHa (Gonadotropin Releasing Hormone analog) treatment is used to suppress ovaries during chemotherapy, and this treatment is considered experimental. GnRHa treatment causes temporary menopause symptoms, but not permanent menopause. These hormones are administered via injection, and are expensive. Clinical trials for a specific cancer sometimes utilize this treatment. The success rate is unknown.

Costs of Ovarian Suppression: The costs of GnRHa treatments can vary, but average $500 per injection. Many insurance companies cover the costs.

Ovarian Tissue Cryopreservation is freezing of ovarian tissue and can be applied to two types of treatment. Ovarian tissue freezing offers the advantages of limited treatment delay, no requirement of a sperm source, no hormonal stimulation required, and perhaps the biggest advantage is that ovarian tissue can be retrieved from pre-pubescent girls even as young as a few months old. The first application, the reimplantation of the thawed ovarian tissue after cancer treatment, has been used on a limited basis for a number of years. However it is considered an investigational procedure as only a handful of births have been accomplished using this technology. The second application is the post-thaw culture of the ovarian tissue and subsequent follicular development and oocyte retrieval, all completed in an in vitro environment. The goal is to thaw the tissue when the woman is ready to have children and mature the follicles in a special gel made from brown algae that supports its three-dimensional development. The mature eggs then would be fertilized and implanted into the woman.  This approach is currently being studied by the Oncofertility Consortium, an NIH supported multi-center study that was developed to address the complex healthcare and quality of life issues that concern young cancer patients whose fertility may be threatened by their disease or its treatment. 

Ovarian Transposition is an outpatient surgical procedure (usually laparoscopically) where the ovaries are moved higher in the abdomen away from the radiation field to minimize exposure and damage. It can be done in both pre- and post-pubescent patients. The success rates have only been measured in terms of the percentage of women who regain their menstrual periods, not in terms of being able to have a live birth. Typically, about half the women will begin menstruating again.

The costs of ovarian transposition and radical trachelectomy are hard to estimate, but both can sometimes be done as part of another necessary surgery so that most of the cost is covered by insurance.

Ovarian Shielding is the use of shielding to reduce the dose of radiation delivered to the ovaries may be discussed with your physician. Radiation shielding does not protect against chemotherapy.