Endometrial cancer more commonly affects older women, for whom fertility is not usually a concern. However, there are some younger women aged 30–40 years, particularly those who have a long history of polycystic ovary syndrome (PCOS), who may be diagnosed with endometrial cancer.
The usual recommended treatment for endometrial cancer is to surgically remove the uterus, including the cervix, and often the fallopian tubes and ovaries as the disease may spread locally to involve these organs.
The cancer poses a significant threat to your subsequent chance of having a baby. This presents a further psychological burden when you are already coping with the distressing news that you have cancer.
In this time of anxiety and concern it is essential that you receive concise and up-to-date information from a recognised fertility expert. You should be referred to a respected unit for this advice. The Reproductive Technology Accreditation Committee (RTAC), under the Fertility Society of Australia (FSA), administers a national Code of Practice and a system for the accreditation of assisted reproductive technology clinics. For a list of accredited clinics in Australia and New Zealand, see the website of the Fertility Society of Australia at www.fertilitysociety.com.au
If the diagnosis of endometrial cancer is made early and the cancer does not invade the muscle of the uterus but appears confined to the lining of the uterus (endometrium) then it may be possible to conserve the ovaries, as the risk of spread to the ovaries in this situation is considered to be very low.
In this situation your ovaries will still be producing eggs and you may consider surrogacy (using your own eggs and your partner’s sperm; the resulting embryo is placed in a surrogate’s uterus).
If you have had a bilateral salpingo-oophorectomy as well as a hysterectomy, you may consider surrogacy using a donor’s eggs, or adoption.
If your ovaries are retained, chemotherapy and/or radiotherapy may affect the number of eggs left within the ovary, and in many cases, accelerate the normal age-related decline in egg numbers. In some cases this may lead to an early menopause, and hence the need to use another woman’s eggs (egg donation treatment) to become pregnant. Hormone replacement therapy can help with managing the symptoms of early menopause.
A surgical procedure called ovarian transposition, which lifts the ovaries as far from the source of the radiation as possible, can reduce the harmful effects of the radiation on the ovaries.
You can talk to a fertility specialist about your options to limit harm to your ovaries from chemotherapy. These may include:
An implant containing a drug called a GnRH analogue may be used to suppress the function of the ovaries for the duration of chemotherapy. There is some evidence that this may limit the harm to the ovaries for women embarking on chemotherapy only.
Ovarian tissue freezing
One potential way to save some eggs for the future is to take a small slice of ovarian tissue. This is done by a minor operation before starting chemotherapy, or at the time of ovarian transposition surgery before starting radiotherapy.
The major downside to this technique is that it is still experimental – very few babies have been born from this treatment. Furthermore, it involves undergoing an operation, and then further surgery to re-implant the ovarian tissue. Evidence suggests that many women do not want the ovarian tissue replaced due to their fear of re-introducing tissue that may still contain cancer cells.
Freezing of eggs
If you are not in a stable relationship, you may opt to go through an IVF cycle. This takes up to one month before starting chemotherapy or radiotherapy. It involves daily injections to stimulate the ovaries, and then after a couple of weeks, a minor surgical procedure to have the eggs collected. These eggs are then rapidly frozen until they are needed. However, this technique should still be considered developmental and success so far is limited.
If you are in a stable relationship and time permits, you may opt to go through an IVF cycle (described above), but in this case your eggs are fertilised with your partner’s sperm and the resulting embryos are frozen until they are used. The freezing of embryos is a more successful procedure than the freezing of eggs.
“Wait and see” policy
Many women find these choices are too hard to make at this time of great anxiety. It may help to talk to the fertility counsellor that is always attached to an IVF unit.