New Doctor Q&A: Shruthi Mahalingaiah, MD
Clinic for Reproductive Health and Cancer
Yawkey Center for Outpatient Care, Suite 10A
32 Fruit Street
Boston, MA 02114
Our services are also available in the following locations:
Clinic for Reproductive Health and Cancer
Center for Gynecologic Oncology
Yawkey Center for Outpatient Care, Suite 9E
32 Fruit Street, Boston, MA 02114
Mass General Waltham
52 Second Avenue, Building 40, Suite 402
Waltham, MA 02451
Mass General Fertility Center - North Shore
Mass General/North Shore Center for Outpatient Care
102 Endicott Street, 3rd floor
Danvers, MA 01923
Explore This Treatment Program
About the Program
Even as cancer treatments continue to improve, many cancer therapies can impact your reproductive health and may even result in infertility. In fact, research has shown that infertility is one of the most common side effects of cancer treatment among people who were diagnosed during childhood or their reproductive years.
If you would like to have biological children, have received a cancer diagnosis and are starting cancer treatment or have already undergone cancer treatments, it is important to learn how your treatments might impact your future reproductive health. While it isn’t always possible to ascertain in advance the long-term impact of cancer treatments, the fertility specialists at the Massachusetts General Hospital Fertility Center will work with your oncology team at the Mass General Cancer Center to provide you with the information you need to make an informed decision about your reproductive health.
If your care team determines that your cancer treatments may impact your future fertility, there are several options available before you begin your cancer treatments that may mitigate the impact of these treatments, including:
- Sperm and oocyte (egg) freezing
- Embryo freezing
- Tissue freezing
Other options, such as surrogacy and egg or sperm donation, are available after treatment should fertility issues arise. Our fertility specialists will work with you and your oncology team to determine which of these options is right for you and coordinate your care.We can help you choose the best fertility option for you.
Each patient is different, and many factors can impact your options and decisions around fertility, including your age, prior medical problems, religious or social circumstances, and the type of cancer treatment you receive. Your oncologist and reproductive endocrinologist can help you understand how your cancer treatment may impact your future fertility.
The Fertility Center at Mass General offers a variety of services to patients before they begin cancer treatments, and your care team can work with you to determine the best options for you.
Services for Women and Girls
Egg (oocyte) and embryo banking
This procedure involves stimulating the ovaries with medications that cause multiple oocytes (eggs) to develop and mature. Mature eggs are then removed using a minor operative procedure. These eggs can be frozen immediately or inseminated using in vitro fertilization (IVF) to make embryos that are then frozen (also called cryopreservation).
Embryo freezing is a very well-known technology, while egg freezing is a newer technology, but both are considered standards in fertility preservation. Many families have had children using these technologies.
One disadvantage of these treatments is that ovarian stimulation can take two to six weeks to complete. Ovarian stimulation also cannot be done in younger girls who have not yet begun to menstruate.
Ovarian shielding and transposition
For women anticipating pelvic radiation, the ovaries can be surgically moved out of the field of radiation through a minimally invasive (laparoscopic) procedure called ovarian transposition. This helps reduce the amount of radiation exposure to the ovaries, while still maintaining their hormonal function. Though the ovaries are not moved back into place after treatment is finished, ovarian transposition still allows for ovarian stimulation and IVF, if fertility is an issue later on.
Ovarian tissue preservation
A whole ovary or a portion of an ovary is surgically removed through a simple procedure, which can often be performed using minimally invasive (laparoscopic) techniques. Strips of this tissue containing oocytes (eggs) are then frozen so that after your cancer treatment is completed, these strips can be surgically replaced in the pelvis. While this technology is still new, Mass General is at the forefront of advancing these new procedures, which have resulted in some successful pregnancies thus far around the world.
However, ovarian tissue freezing cannot be used for every type of cancer, as some types of cancer, such as leukemia, carry a risk of reintroduction of cancer cells. One advantage of ovarian tissue freezing is that it can be accomplished quickly without the time required to stimulate the ovaries for egg or embryo freezing.
Medical intervention is a newer area of oncofertility treatment, so it is still considered somewhat innovative. Certain medications may mitigate the effects of chemotherapy on ovarian function, though these may not be completely effective. These medications (gonadotropin-releasing hormone agonists) temporarily stop the monthly hormonal fluctuations that occur in women who are menstruating. Almost half of women receiving cancer treatment at Mass General use this type of medication.
While the effectiveness of these medications for fertility preservation is yet to be definitively proven, they temporarily stop menstruation. It can be advantageous to prevent menstruation during cancer treatment, as certain therapies can result in anemia (low iron).
We are also investigating a number of other medications for fertility preservation in women.
Services for Men and Boys
Sperm cells are collected through traditional methods and then frozen and stored for later use. This is a very well-established treatment option.
Testicular sperm extraction is also available, if needed, for patients who cannot collect sperm in the traditional way. This procedure is more invasive, but it can produce samples that may be viable for pregnancy. Testicular tissue preservation, which is similar to ovarian tissue preservation, is available to pediatric patients, but is still considered experimental.
Some cancer therapies make it challenging to build a family in the traditional manner, and the Fertility Center offers support to families, no matter their circumstances.
Third-party reproduction can be used to obtain donor eggs, donor sperm and even to find a gestational carrier (surrogacy). Our specialists will work with you to determine what services will best meet your needs.
If you would like to have biological children, have received a cancer diagnosis and are starting cancer treatment or have already undergone cancer treatments, it is important to learn how your treatments might impact your future reproductive health. Our specialists can help.
- Medical Director, Clinic for Reproductive Health and Cancer
- Medical Director, Third Party Reproduction
Mass General has one of the longest-standing fertility preservation programs in the country. The publications listed here highlight our success rates, changes in the clinical setting to facilitate immediate care and potential for medical advances in fertility preservation.
Thomson A, Cardozo E, Dickinson K, Karmon A, Wright DL, Sabatini ME. Ovarian Stimulation and In-vitro Fertilization Outcomes of Cancer Patients Undergoing Fertility Preservation Compared to Age Matched Controls: A 17-year experience. Journal of Assisted Reproduction and Genetics. 2015 Apr; 32(4): 587-96.
Hariton E and Bortoletto P, Cardozo, Hochberg EP, Sabatini ME. The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists. Accepted for publication, Journal of Patient Experience. November 2016.
Cardozo ER, Karmon, AE, Longacre MM, Sabatini, ME. The Role of Demographics and Diagnosis on Fertility Preservation Decision Making Among Female Cancer Patients of Reproductive Age. Accepted for publication, Journal of Reproductive Medicine, June 2016.
Sabatini ME, Ellisen LW. Women’s Health Issues for BRCA Mutation Carriers. (Book Chapter) American Society of Clinical Oncology Educational Book. 2016;35:14-17.
Kano M, Sosulski AE, Zhang L, Saatcioglu HD, Wang D, Nagykery N, Sabatini ME, Gao G, Donahoe PK, Pépin D. AMH/MIS as a contraceptive that protects the ovarian reserve during chemotherapy. Proceedings of the National Academy of Sciences of the USA. 2017 Feb 28;114(9): E1688-E1697.
Pépin D, Sabatini ME, Donahoe PK. Müllerian inhibiting substance/anti-Müllerian hormone as a fertility preservation agent. Current Opinion in Endocrinology, Diabetes and Obesity. 2018 Dec;25(6):399-405.
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