IVF, fertility preservation and other paths to parenthood

Women with early menopause who wish to try to have a child may seek to do so using assisted reproductive technology (ART), surrogacy, adoption, or by becoming a foster parent. Fertility preservation is increasingly offered to women diagnosed with cancer, due to the risk that cancer treatment will cause fertility loss, and also to women who need or choose to have gynaecological surgeries (e.g. oophorectomy or hysterectomy with oophorectomy). ART options for women depend largely on the cause of EM, what medical treatments they have had, other health issues, and potential financial costs. Surrogacy, adoption and foster care also require time and financial costs. For more information, please see the Box at the end of this Talking Point.

About two thirds of the women we interviewed talked about their experiences of or thoughts about trying to have a child using ART, or via surrogacy, adoption or foster care. Most of these women had either not had children before experiencing EM, or had not had as many children as they wanted (see Emotional impact of early menopause and fertility loss).

Experiences of women with spontaneous EM/POI

Most women diagnosed with spontaneous EM had thought about or tried other ways to have a child, particularly those who had no children. Two women had tried IVF using their own eggs. Melinda tried IVF because of fertility problems affecting her husband, then discovered that Melinda had a very low ovarian reserve. Although their first attempt at IVF was successful and they conceived their daughter, Melinda later found out she had been perimenopausal at the time; she was diagnosed with EM when her daughter was a toddler. A second attempt at IVF was unsuccessful and she and her husband decided not to try again.

After being diagnosed with spontaneous POI at 37, Jenni tried IVF. Even though she knew the chances of success were low, she found it ‘very, very hard’ when it ‘didn’t work.’ 

Other women recounted discussing ART with health professionals, but not pursuing it. Most described being told that IVF using a donor egg was their ‘only option’, though Vicki, who had Turner Syndrome, had the option of using her mother’s ovarian tissue, which she had had frozen for Vicki when she was young.

Women’s reasons for not trying IVF varied. Ella recalled not following up on IVF because she was single, which meant she would have needed a donor egg and donor sperm. She explained that ‘because I grew up without a father, I have certain reservations about IVF and [donor] sperm, and people not knowing their true father.’ For Kirsty, the potential impact of IVF on her relationship with her husband was a concern, given the couple had already endured a miscarriage, early menopause, and Kirsty’s diagnosis with the BRCA 2 gene mutation. Other women were concerned about the effect of IVF or pregnancy hormones on their health and bodies.

Lorena shared her reasons for becoming interested in adoption, instead of IVF with a donor egg. 

Experiences of women with medically-induced EM

Most women with medically-induced EM described being offered fertility preservation, including ovarian suppression therapy to try to protect their ovaries during chemotherapy and radiotherapy, egg harvesting and freezing, or ovarian tissue harvesting and freezing.

Some women found fertility preservation confronting or challenging, including Kate who underwent IVF before chemotherapy for breast cancer: ‘it was very intense and just another thing that I just had no idea was going to be a part of this cancer journey.’ A few commented on the time pressure they felt to begin chemotherapy or have surgery rather than undergo IVF. As Julia said, ‘it’s a real difficult balance to know whether you should be continuing to try and do fertility preservation, or life preservation should be starting.’

Sylvia underwent two unsuccessful egg harvesting cycles before having a hysterectomy and oophorectomy for uterine cancer. She reflected on the difficulty of making decisions about cancer treatment and fertility that ‘impact your life’ at that time. 

Other women described positive experiences of fertility preservation. Joanna said, ‘even though I’m pretty confident I’ll never end up using the ovarian tissue or attempting [IVF], I think it’s still good that it was a choice and an option.’

After having a radical hysterectomy for ovarian cancer, Alex lost her ‘entire reproductive system.’ She was grateful to her fertility specialist for presenting her with ‘so many options’ for having a child using a family member’s ‘DNA.’

A few women described deciding not to have fertility preservation, either because they had the children they wanted, or they did not wish to have children.

Yen-Yi did not want to have children, but continued to see her fertility specialist/gynaecologist once a year in relation to the effects of cancer treatment on her menstrual cycle.

Although a number of women had ovarian tissue or eggs harvested and frozen, or embryos frozen, only a couple described using these in IVF later on; Louise who was in the process of having embryos using a donor egg transferred, and Julia who was in the late stages of pregnancy after a successful ovarian tissue reimplantation.

Julia shared her experience of becoming pregnant as a result of ovarian tissue harvesting and cryopreservation, followed by IVF. At the time this was an experimental form of fertility preservation (long clip).

The desire for a ‘biological’ child and fertility options

Women who were interested in trying to have a child had different perspectives on the importance of having a child with a genetic link to themselves (or a partner or family member), or that they could carry. These perspectives shaped the fertility options they were willing to consider, at least initially.

Some described trying ART techniques in order to reassure themselves that they had ‘tried everything [they] possibly could’ to have a ‘biological’ child, and were less interested in fostering or adoption. For Jenni, adoption or fostering and having one’s own child were ‘two different worlds. One is not a replacement for the other.’ A couple of women described a sense of attachment to frozen eggs or ovarian tissue for this reason, including Linda who said, ‘I often still wonder wistfully about my eggs.’

Joanna had ovarian tissue frozen before commencing chemotherapy for Hodgkin’s Lymphoma but became a parent when her same-sex partner underwent IVF using donor sperm. She reflected on her reasons for having wanted her own child, and how she came to terms with not being able to.

Other women said they were less concerned about the idea of having a genetic connection to their own child. They were only willing to pursue ART or IVF if there was some chance of success, and tended to be more open to adoption or fostering, though these options were also seen as not straightforward.

Ella shared her thoughts about surrogacy and fostering.

Natalie and her husband looked into adoption, but were told they would unlikely to be chosen due to Natalie’s age. In the end they ‘came to the conclusion’ they would not be able to have children.

What are the options for women diagnosed with early menopause who wish to have a child?

Women with spontaneous early menopause (EM) / premature ovarian insufficiency (POI) have a lifetime chance of spontaneously conceiving of 1-5%. If they have an intact uterus, they are usually advised to consider IVF using donor eggs or embryos. If they have had a hysterectomy they will need to consider surrogacy, or if they are in a same-sex relationship their partner may be willing to carry a pregnancy.

Women with medically-induced EM as a result of surgery (bilateral oophorectomy or hysterectomy with oophorectomy) for non-cancer conditions may be offered fertility preservation before their surgery. This may involve IVF and freezing of eggs (or embryos), to allow women to become pregnant after surgery. If they have their own uterus they can carry a baby; if not, they need to consider surrogacy (or if they are in a same-sex relationship their partner may be willing to carry a pregnancy).

Women with medically-induced EM as a result of chemotherapy, radiotherapy or surgery (bilateral oophorectomy or hysterectomy with oophorectomy) may be offered fertility preservation before chemotherapy / radiotherapy / surgery. This may involve IVF and freezing of eggs, embryos, or ovarian tissue before chemotherapy and radiotherapy, and the use of pharmacological ovarian suppression therapy (e.g. goserelin) during chemotherapy and radiotherapy to try to protect the ovaries. After active treatment has ended, women with frozen eggs, or embryos may try IVF (carrying the baby themselves if they have a uterus, and if not using a surrogate, or if they are in a same-sex relationship their partner may be willing to carry the baby). Women with frozen ovarian tissue may have the tissue re-implanted to see if ovarian function can be re-started. If this succeeds, they can try conceiving naturally or via IVF.

Women undergoing adjuvant endocrine (hormone) therapy as part of breast cancer treatment typically do not know if they have experienced EM until they stop taking ovarian suppression medication (see Finding out about medically-induced early menopause). Women in this situation are likely to have already been offered fertility preservation before starting chemotherapy. They may decide to temporarily stop adjuvant endocrine (hormone) therapy to try IVF, or wait until they finish.

Women who have experienced oestrogen sensitive cancer may be reluctant to try IVF or become pregnant because of increased oestrogen levels triggered by IVF or pregnancy. Women in this situation should discuss their options with their health practitioner.

Women with early menopause who not wish to try IVF but would still like to have a child may wish to explore adoption or foster care.

Further information:

Talking Points (Women’s experiences)

Talking Points (Health Practitioners)

Other resources