Fertility treatment for young women This information is an extract from the booklet Fertility – support for young people affected by cancer. You may find the full booklet helpful. We can send you a free copy – see page 8.

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Fertility treatment If you aren’t producing eggs If you can’t have a pregnancy yourself If you can’t have sexual intercourse What if the treatment doesn’t work?

Fertility treatment Fertility treatment is also called assisted conception. It is medical treatment used to help people who have difficulty getting pregnant naturally. The term ‘fertility treatment’ covers a lot of different treatments. The main ones are discussed on pages 3–6.

Getting fertility treatment You usually start by seeing your GP. They may arrange for you to have some tests. They will then refer you to an NHS doctor specialising in fertility issues. You can ask to be referred to a private doctor if you’d like. If you want to have treatment as a couple rather than on your own, your partner may need to have some basic fertility tests. These tests are free for NHS patients.

At the fertility clinic The fertility clinic may be called the ‘department of reproductive medicine’ or the ‘assisted conception unit’.

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Fertility treatment for young women

If you’ve already had fertility tests, the results will be sent to the fertility specialist at the clinic. At the clinic, the specialist will discuss your situation with you. They will answer any questions you have, arrange for some further tests and discuss any suitable treatments with you.

Which fertility clinic will I go to? This depends on whether you’re an NHS patient or you want to pay for private treatment. If you’re an NHS patient, your GP will usually suggest a particular clinic. If you’ve already been in contact with a fertility clinic for egg or embryo storage, or to have your fertility checked, it may be possible for you to go back to the same clinic. If you want to have private treatment, you can choose which clinic to go to, but you may need a referral letter from your GP. You can get details of all the fertility clinics in the UK by contacting the Human Fertilisation and Embryology Authority (HFEA – visit hfea.gov.uk or call 020 7291 8200). The HFEA has a free patients’ guide with advice about how to choose a clinic and questions to ask about the treatments.

Will I have to pay for fertility treatment? Your GP or fertility specialist will let you know whether you’re able to have fertility treatment free on the NHS. Although there are national guidelines about providing fertility treatment, there are still local differences. It’s best to check with the clinic you’ve been referred to about this. If you’re not eligible for NHS treatment or are worried that you may have to wait a long time for treatment in your area, you might consider private treatment. There are no standard charges for private treatment, so you’ll need to contact clinics directly to find out how much they charge. Clinics should be able to give you information about treatments, including the success rates and costs. You can then make an appointment to discuss the treatment more.

Fertility treatment for women who are single or in a same-sex relationship Being single or in a same-sex relationship does not exclude you from treatment, but it may affect your eligibility for free NHS treatment.

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Fertility treatment for young women

Staff in fertility clinics will need to know if you’re single or in a same-sex relationship. This is so they can advise you about certain legal aspects of becoming a parent.

Advice and support if you’re single or in a same-sex relationship If you’re single or in a same-sex relationship, you can ask your GP to refer you to a specialist who can advise you about local fertility treatment services. You could contact a national support group for confidential advice, such as Infertility Network UK (visit infertilitynetworkuk.com or call 0800 008 7464). If you’re in a same-sex relationship, you may want to contact an organisation such as the Lesbian and Gay Foundation (visit lgf.org.uk or call 0845 3 30 30 30).

If you aren’t producing eggs If you’re not producing any eggs at all, you won’t be able to have your own biological child unless you stored embryos or eggs before your cancer treatment. You may be able to use donated eggs or embryos.

Using frozen embryos When the frozen embryos are needed, they are unfrozen (thawed) and placed in the womb to see if they will implant and develop. This is usually done one embryo at a time. Both you and your partner, whose sperm was used to make the embryo, must give consent to do this. Before your embryos are frozen, it’s important you find out whether your IVF (in vitro fertilisation) unit uses vitrification or slow freezing. Vitrification is just as effective as using fresh embryos to get pregnant. But not all IVF units use this method, and instead use slow freezing because it’s cheaper. With slow freezing, pregnancy rates are generally lower.

Using frozen eggs When the frozen eggs are needed, they are thawed and can be fertilised by mixing them with sperm in a laboratory. The sperm may be from your partner or a donor. In the past, the chance of a successful pregnancy from frozen, unfertilised eggs was very low because of the technology used to freeze the mature eggs. However, a new technology called Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk

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Fertility treatment for young women

vitrification means that the pregnancy rates from vitrified mature eggs are now as good as fresh eggs. Not all IVF units can perform vitrification on eggs so it is important that you speak to a specialist who can offer this.

Using frozen ovarian tissue A new and experimental technique is to take and store samples of ovarian tissue that contain many eggs. The ovarian tissue can then be put back into the body at a later date. This technique is at a very early stage of development and hasn’t been widely used. If you’re suitable for this procedure, you’ll probably have to travel to a specialist hospital for it.

Using donated eggs or embryos If you don’t have any frozen embryos or eggs, the only fertility treatment available is to use eggs or embryos that have been donated by someone else. People who donate eggs or embryos are carefully chosen. Their general health is checked and they’re offered counselling to make sure they understand exactly what it means to help infertile people in this way. Occasionally, it might be possible to use a donor that you know, such as a sister or friend. But this also requires careful thought and counselling for everyone involved. If you decide to have fertility treatment using eggs or embryos from a donor, you will also be offered counselling and information about what it involves. There can often be a waiting list for this treatment. Using donated eggs If your partner is fertile, you may be advised to have treatment using donated eggs. The donated eggs are fertilised with your partner’s sperm in the laboratory. The embryos that are formed are then put into your womb. You’ll need to have treatment with hormones before the embryos are implanted, and during the early part of the pregnancy. Because egg donors are usually young women with good fertility, the chances of a successful pregnancy with this treatment are quite high.

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Fertility treatment for young women

Using donated embryos If both you and your partner have a fertility problem, you may be advised to try using donated embryos (eggs that have already been fertilised by sperm, and then frozen). The embryos are thawed and put into your womb. You’ll need to take hormones before the embryos are implanted, and possibly during the pregnancy.

If you can’t have a pregnancy yourself Surrogacy Some women aren’t able to have a pregnancy because their womb has been removed by surgery, or pelvic radiotherapy has damaged the lining of the womb. In this situation, surrogacy is an option. Surrogacy is where another woman, called the surrogate (or host), becomes pregnant and gives birth. If you are able to use your own eggs, an embryo is made by fertilising your eggs with your partner’s sperm (or with donated sperm). This is done using IVF. The embryo is placed in the surrogate’s womb and she will carry the pregnancy. If you are unable to use your own eggs, IVF can be carried out with donated eggs, which could be from the surrogate or another woman. Another option is for the surrogate to be ‘inseminated’ with your partner’s sperm (or donated sperm). The sperm is frozen until it’s needed. The surrogate will have tests and scans to monitor her menstrual cycle and show when she is about to release an egg. When the egg is about to be released, the sperm is thawed and placed into the surrogate’s womb, with the hope of fertilising her egg. This option always involves using the surrogate’s own eggs. In this case, the surrogate mother is the legal mother of the baby, but you and your partner can apply to the courts to have full parental legal responsibilities transferred to you (providing you are married or in a civil partnership). This means you become the baby’s legal parents. If you and your partner aren’t married, it is still possible to adopt the baby but it is slightly more complicated. In all cases, it’s important to involve a lawyer who specialises in surrogacy so they can guide you through how to adopt the baby. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk

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If you can’t have sexual intercourse Some people can’t have sex because of physical changes caused by the cancer or its treatment. It may be possible for the doctors to take your eggs and use them in IVF or intracytoplasmic sperm injection (ICSI) treatment. For IVF you will be given a course of drugs to make your ovaries produce more mature eggs than normal. A small operation is then done to collect the eggs. A sedative is given to relax you, and a fine needle is put through the top of your vagina and into an ovary. The eggs can be collected through the needle. The eggs are then fertilised in the laboratory by mixing them with sperm. Usually, only one or two of the resulting embryos is then placed in your womb a few days later, in the hope that this will lead to a pregnancy. For ICSI the eggs are collected in the same way as for IVF, but they are fertilised by injecting a single sperm directly into each egg. The rest of the process is the same as for IVF. These treatments may allow you to have your own biological children. Where this isn’t possible, you may want to think about using donated eggs or embryos (see pages 4–5) or surrogacy (see page 5).

What if the treatment doesn’t work? It’s always upsetting if the treatment fails. The doctors at the clinic can advise you on what your chances of success might be if you tried again. Whether you have another fertility treatment will depend on whether it feels right for you, emotionally. There may also be other issues to consider, including whether or not you have to pay. Counsellors in fertility clinics can help by talking to you about everything. There are also support groups for people who have decided to end fertility treatment when they haven’t achieved a pregnancy, such as Infertility Network UK (visit infertilitynetworkuk.com or call 0800 008 7464).

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Fertility treatment for young women

More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don’t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Fertility – support for young people affected by cancer or any other cancer information, visit be.macmillan.org.uk or call 0808 808 00 00. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. © Macmillan Cancer Support 2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ

REVISED IN DECEMBER 2014 Planned review in 2017

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Fertility treatment for young women

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