What are the options for women after treatment?
It is important to assess the residual ovarian function after treatment for cancer. If the periods have stopped and especially if menopausal symptoms are present (hot flashes, night sweats, etc.) the ovaries have been damaged. Generally a blood test for FSH (follicle stimulating hormone) and estrogen will indicate whether the ovaries are still functioning. If the blood tests indicate the ovaries are not functioning, the ovaries may or may not recover. Sometimes periods start up again several months after the completion of treatment. Even irregular periods indicate the potential for conception. The challenge in the case of intermittent ovarian function is to identify the time of ovulation so that intercourse can be timed optimally. In this way, women who have had cancer treatment are like perimenopausal women. However, unlike perimenopausal women in their late 40s or 50s, cancer survivors with eggs still present in their bodies have a better potential for becoming pregnant. Monitoring ovarian function with blood test and ultrasounds is the best way to identify the time of ovulation.
For women in whom there seems to be no residual ovarian function, it is possible to get pregnant and carry a pregnancy using donated eggs (oocytes). In some cases, the donor is known to the recipient (like a sister or friend) but, more commonly, women use anonymous donors. The donor is treated with fertility drugs so that she will produce a large number of eggs. After egg retrieval, the eggs are fertilized with the recipient’s partner’s sperm. The fertilized eggs are placed into the uterus of the recipient after priming with hormones so that the uterus is prepared to accept the pregnancy. Most in-vitro fertilization programs have a donor oocyte program and accept patients up to the age of 50. The success rate using anonymous donors is about 50% per attempt. The cost is approximately $20,000 per attempt.