Version May 2024
| Description | Investigational | Comments | |
| Cryopreservation of embryos for future implantation | Typically requires ovarian stimulation, which takes 10 to 14 days from the beginning of a menstrual cycle. Oocytes are harvested under ultrasound guidance and fertilized in vitro. | No | Requires sperm from the woman's partner. If no partner, then donor sperm can be used. Induction of high estrogen levels during ovarian stimulation is a concern in women with estrogen-responsive malignancies. Aromatase inhibitors can be used to minimize estrogen exposure. Costly. Approximately USD $8000 to 12,000 per cycle, USD $500 to 1000/year storage fees. |
| Oocyte cryopreservation (mature oocytes) | Typically requires ovarian stimulation, which takes 10 to 14 days from the beginning of a menstrual cycle. Oocytes are harvested under ultrasound guidance and frozen without being fertilized. | No | Induction of high estrogen levels during ovarian stimulation is a concern in women with estrogen-responsive malignancies. Aromatase inhibitors can be used to minimize estrogen exposure. Costly. Approximately USD $8000 to 12,000 per cycle, USD $500 to 1000/year storage fees. |
| Oocyte cryopreservation (immature oocytes) | Does not require ovarian stimulation. Germinal oocytes are harvested under ultrasound guidance and frozen without being fertilized. | Yes | Only a few pregnancies have been reported. |
| Ovarian cryopreservation and transplantation | Outpatient surgical procedure to obtain strips of ovarian tissue, which are frozen and reimplanted when pregnancy is desired. | No | Ovarian transplantation is not recommended in women at increased risk of developing ovarian cancer. |
| Gonadal shielding during radiation therapy | Shielding gonads during radiation therapy reduces gonadal exposure to scatter radiation. | No | Not possible if gonads are in the radiation field. Requires expertise to properly place shields. |
| Ovarian transposition (oophoropexy) | Outpatient surgical procedure to reposition the ovaries away from the radiation field. Should be performed just before radiation therapy to minimize chance that ovaries will return to their former position. | No | Approximately 50% chance of success. Ovaries may need to be repositioned to allow assisted or natural conception. |
| Trachelectomy | Inpatient surgical procedure to remove the cervix while preserving the uterus. | No | Only useful for women with early-stage cervical cancer. Prior to attempting pregnancy following trachelectomy, the patient may require an abdominal cerclage. Pregnancy following abdominal cerclage may be complicated due to the difficulty in differentiating preterm labor from preterm contractions, the risk of uterine rupture, and the need for cesarean delivery. |
| Ovarian suppression with gonadotropin-releasing hormone (GnRH) analogs or antagonists | Administer before and concurrent with chemotherapy to protect ovarian tissue. | Yes | True efficacy unknown. No randomized trial has shown benefit to fertility. Side effects include hot flashes and vaginal atrophy. Suppression of menses is a benefit in women at risk of menorrhagia from thrombocytopenia. Approximately USD $500/month. |
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