Understanding Fertility Preservation After an Ovarian Cancer Diagnosis

For women of reproductive age diagnosed with ovarian cancer, fertility preservation is often a conversation that comes too late, sometimes only after surgery has already removed the option to preserve an affected ovary. Marisa Gigg, M.D., FACOG, an obstetrician-gynecologist and reproductive endocrinologist and infertility specialist at HRC Fertility West Los Angeles, explains why early referral to a reproductive specialist matters so much, and what fertility preservation actually looks like depending on whether cancer affects one ovary or both.

For Ovarian Cancer Awareness Month, Gigg breaks down the available options, from fertility-sparing surgery to oocyte and embryo cryopreservation, and addresses common misconceptions patients have about cost, timing and what’s possible before treatment begins. She also emphasizes why close, early collaboration between oncologists and reproductive specialists can make a meaningful difference for patients hoping to preserve the possibility of a future pregnancy.

When should fertility preservation first come up in the conversation after an ovarian cancer diagnosis, and how often does that timing happen in practice?

Marisa Gigg, M.D., FACOG: Ideally, fertility preservation should be discussed as soon as ovarian cancer is suspected in a woman of reproductive age. Because ovarian cancer is typically diagnosed through surgical pathology, fertility preservation discussions can unfortunately occur after the opportunity to preserve the affected ovary has already been removed. In practice, fertility preservation is not always discussed before ovarian cancer surgery, which is why early referral to a reproductive specialist is so important.

What fertility preservation options are typically available to patients before chemotherapy or surgery begins, and how does an ovarian cancer diagnosis specifically affect which options make sense?

MG: Oncologic fertility preservation options include oocyte or embryo cryopreservation, ovarian tissue cryopreservation and fertility-sparing surgery. In patients with ovarian cancer, we would not attempt to retrieve oocytes from or cryopreserve tissue from an ovary containing a tumor because of concerns about stimulating or potentially reintroducing malignant tissue. However, some patients with early-stage ovarian cancer affecting only one ovary may be candidates for fertility-sparing surgery, such as unilateral salpingo-oophorectomy rather than removal of both ovaries. In selected patients, the remaining ovary can then undergo stimulation to maximize oocyte or embryo yield before chemotherapy, if indicated. For patients with tumors involving both ovaries, it may still be possible to preserve the uterus, allowing them to carry a future pregnancy using donor eggs or previously cryopreserved eggs or embryos.

What are the most common misconceptions patients have about fertility preservation, whether that’s about cost, timing or what’s even possible?

MG: Patients often underestimate the resources available to them, as well as how quickly fertility preservation can be initiated. Depending on where they live and what type of insurance they have, many patients with cancer may have coverage for fertility preservation, and pharmaceutical assistance programs can help reduce the cost of fertility medications. At HRC Fertility, we offer discounted or subsidized fertility treatment for patients with cancer diagnoses. We used to start ovarian stimulation only at the beginning of a patient’s menstrual cycle, but data now show that outcomes are similar when stimulation is started at other points in the cycle. This flexibility can be particularly valuable for patients with cancer, as we can sometimes complete two stimulation cycles in a single menstrual cycle and maximize the number of eggs retrieved before treatment begins.

Why is early collaboration between oncologists and reproductive specialists so important, and what does that coordination look like when it’s working well?

MG: Early collaboration between oncologists and reproductive specialists is essential. I see urgent oncofertility consultations within 24 hours of referral whenever possible, because many cancer treatments can have an irreversible impact on fertility. The goal is for the oncologist and reproductive specialist to work together from the beginning to develop a plan that provides the necessary cancer treatment while preserving as much fertility potential as safely possible.

For a young woman who’s just been diagnosed and completely overwhelmed, what would you want her to know about her fertility options before treatment starts?

MG: I would first want her to know that she does not have to navigate this alone. I would encourage her to schedule a consultation with a fertility specialist experienced in oncofertility. If she is a candidate for ovarian stimulation, we can often complete the process in two to three weeks, which in many cases causes little to no delay in starting chemotherapy after surgery, if needed. We can also work closely with her gynecologic oncologist to determine whether fertility-sparing surgery is an option. For carefully selected women with early-stage ovarian cancer, fertility-sparing surgery can preserve the possibility of future pregnancy without evidence of compromising overall or disease-free survival. The most important thing is to have these conversations early, because there may be more options than patients initially realize.