I haven’t started my family- do I need to remove my ovaries straight away?

If you’re a female, thinking about testing, know you want kids and are aware that one of the options for managing ovarian cancer risk is to have your ovaries removed, you are likely confused about how all of this is compatible.  

“Will I be told to remove my ovaries straight away?”  

“But what if I want kids and haven’t yet?”   

“How can I have children if I do not have ovaries?”  

This topic can be hugely emotive for many women. The idea that you may need to choose cancer prevention over your dream of having a family is scary. Thankfully though, this should not have to be the case. And here is why:  

  1. A clinician will never force you to have risk reducing surgery- not before or after kids. Their role is to discuss both the benefits, risks and implications of surgery with you, allowing you to make your own personal choice about if and when to go ahead. 
  2. The surgery (officially called a risk reducing salpingo-oophorectomy (RRSO) is often not offered until a female is over the age of 35. This is because the risk of ovarian cancer does not usually begin to rise before the age of 35 years. Therefore, depending on the age of testing, surgery may not even be on the cards until some years later, leaving time for you to have/grow your family in the way that you want.  
  3. Some women who are beginning to consider surgery (due to their ovarian cancer risk increasing) but have not yet had children can also explore egg or embryo freezing. However, this needs to involve a conversation with a fertility specialist and a gynaecologist with a special interest in risk management, who can discuss the risks and limitations of this option in detail to help make an informed decision. Ideally surgical prevention (i.e. removal of ovaries) should be undertaken only once you have completed your family.  

BRCA testing and managing ovarian cancer risk can be compatible with having a family. It is really important that any woman considering the best time to undergo BRCA testing (or not) takes in to account their fertility wishes, reproductive choices alongside the recommended timing and options of risk reducing surgery for ovarian cancer. This should also be considered in conjunction with thinking about breast cancer risk management options, especially since breast cancer risk rises before ovarian cancer.  

If you are thinking about testing but want to discuss this further with a genetic counsellor (and are living in England) then you can do this via the NHS Jewish BRCA Testing Programme. Genetic counsellors can be accessed via their helpline on +44 20 3437 6001. The helpline is open Mon-Fri 9am-5pm with extended hours until 7pm on a Wednesday.