Receiving a diagnosis of endometrial cancer (EC) can feel like a major setback if you’re not done building your family. Although EC is rare among premenopausal women, it can still occur in people of reproductive age.
The standard treatment for EC is surgery to remove the uterus and possibly the cervix, ovaries and fallopian tubes. Nevertheless, there are some options that may help you preserve your fertility if you find yourself in this situation.
Progestin therapy
If you’re diagnosed with EC in its early stages, you may be able to postpone or even avoid surgery altogether by using high doses of progestin-based treatments. Progestin is a synthetic form of the hormone progesterone and is sometimes used to treat EC, especially in younger women who have fertility concerns.
Read more about EC treatment and care
Individuals with early-stage EC may also receive an intrauterine device (IUD) that releases a progestin called levonorgestrel. Some studies have shown that people who receive both the levonorgestrel IUD and a class of drugs called gonadotropin-releasing hormone agonists have more promising pregnancy outcomes after treatment than those who use the IUD alone.
It might sound counterintuitive to receive an IUD to preserve your fertility. However, the device is only used to help thin the lining of the uterus to reduce the spread of EC cells. It is later removed after treatment once you’re ready to try for a baby.
Progestin therapies carry higher risks of cancer progression and recurrence than a hysterectomy. Still, many patients are able to achieve a complete response — even if temporarily — using this treatment option, and it can give you the time needed to have a successful pregnancy. Doctors usually recommend a hyterectomy after pregnancy due to the risk of relapse.
Tumor resection
In some cases, especially when the cancer has not yet spread significantly, tumor resection can be used to remove the cancerous tissue while leaving the majority of the uterus intact. This approach should be done in combination with progestin therapy or a levonorgestrel IUD.
Many patients with EC have pursued tumor resection and been able to have successful pregnancies. As with progestin therapy, though, resection carries a risk of recurrence.
Guidelines usually recommend that a hysterectomy be performed once childbearing is complete to help minimize the chances of the cancer coming back.
Cryopreservation
Cryopreservation refers to the freezing of embryos, eggs or parts of the ovaries.
If you decide to pursue egg retrieval, you’ll need to take medications for a few weeks to help stimulate your ovaries. Once the eggs are mature, your doctor will use a transvaginal ultrasound and needle to obtain the eggs. The eggs can be frozen on their own, or in vitro fertilization can be used to fertilize the egg and create an embryo, which is then frozen.
You can also choose to have the egg-producing portion of an ovary removed via surgery and frozen. If you receive chemotherapy or radiation instead of surgery, this option can help protect your ovaries during treatment. The tissue can be placed back in your body after cancer treatment, allowing you to become pregnant if your uterus hasn’t yet been removed.
If you do need surgery to have your uterus removed, pregnancy is no longer possible. If this is the case, you can consider pursuing surrogacy using the eggs or embryos you had frozen before treatment.
With any of these options, cost will likely play a factor. Surrogacy can cost over $100,000, while cryopreservation can cost $10,000 for each cycle. Some insurance plans cover fertility preservation for cancer patients. Additionally, some states require that all insurance plans cover fertility preservation when it’s medically necessary. Insurance is more likely to cover the cost of egg freezing and in vitro fertilization than gestational surrogacy, which is considered optional.
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