Fertility Preservation in Cancer Patients
A cancer diagnosis can change a person’s life suddenly. While diagnosis, staging, surgery, chemotherapy, radiotherapy, or targeted treatments become the main focus, future fertility may be overlooked. However, some cancer treatments can affect the ovaries, testes, uterus, hormonal system, or reproductive organs and may reduce fertility or cause permanent infertility.
Why should fertility be discussed before cancer treatment begins?
Because many fertility preservation options are most effective when performed before cancer-directed therapy. Every child, adolescent, or adult with reproductive potential should be informed, whenever possible, before treatment starts.
What is fertility preservation?
Fertility preservation refers to medical strategies used to protect a person’s chance of having biological children in the future. In cancer care, this is often called “oncofertility,” a field that brings oncology and reproductive medicine together.
Fertility preservation is not limited to freezing eggs, sperm, embryos, or tissue. It also includes individualized counseling based on age, cancer type, treatment urgency, planned chemotherapy or radiotherapy, surgical procedures, current reproductive reserve, safety of future pregnancy, and personal preferences.
Which cancer treatments can affect fertility?
The risk is not the same for every patient. It depends on the type of cancer, treatment plan, drug dose, radiation field, age, and baseline reproductive function.
Cancer treatments that may affect fertility include:
Chemotherapy, especially drugs that can damage ovarian or testicular cells
Radiotherapy to the pelvis, lower abdomen, brain/pituitary region, or testes
Surgery involving the ovaries, testes, uterus, cervix, or other reproductive organs
Certain hormone treatments
High-dose therapy before stem cell or bone marrow transplantation
Some targeted therapies and immunotherapies, for which the fertility risk may not always be fully known
What if cancer treatment needs to start urgently? Are there still options?
Yes. Some methods can be arranged quickly. Sperm freezing can often be completed within a short time. Egg or embryo freezing usually requires brief ovarian stimulation, but modern “random-start” protocols may allow treatment to begin at different points in the menstrual cycle. If treatment cannot be delayed, ovarian tissue freezing may be considered in selected patients.
Symptoms: How does fertility loss present?
A decline in fertility often causes no symptoms at first. Therefore, the absence of symptoms does not mean fertility is unaffected.
Possible signs in females may include:
Irregular periods
Absence of periods
Hot flashes or night sweats
Vaginal dryness
Reduced sexual desire
Difficulty becoming pregnant
Early menopause symptoms
Possible signs in males may include:
Low sperm count
Reduced sperm motility or abnormal sperm shape
Low testosterone
Reduced sexual desire
Erection or ejaculation problems
Difficulty achieving pregnancy with a partner
However, fertility may be affected before any symptoms appear. This is why counseling should ideally take place before cancer treatment begins.
How is fertility risk assessed?
Fertility preservation requires collaboration between the oncology team and reproductive specialists. The evaluation aims to answer several key questions.
What is the patient’s age and pubertal status?
Options differ for children, adolescents, and adults.
How urgently must cancer treatment start?
In some patients, a few days or weeks may be enough for fertility preservation. In others, time may be very limited.
What is the fertility risk of the planned treatment?
Chemotherapy agents, radiation field, dose, and surgical plan are important factors.
How is ovarian reserve assessed in females?
Age, anti-Müllerian hormone, and ultrasound assessment of antral follicle count may be used together. No single test gives the full picture.
How is sperm production assessed in males?
A semen analysis can assess sperm count, motility, and morphology. Some males may already have impaired sperm quality at the time of cancer diagnosis.
Fertility preservation options for females
1. Egg freezing
Egg freezing is an established option for postpubertal and adult females. The ovaries are stimulated with medication, mature eggs are collected, and the eggs are frozen for future use.
This option may be suitable for patients who:
Do not have a partner
Do not wish to create embryos
Want to decide on the sperm source in the future
Prefer to retain individual control over the stored eggs
The chance of future success depends mainly on age, the number of eggs frozen, and egg quality.
2. Embryo freezing
Embryo freezing involves collecting eggs, fertilizing them with sperm, and freezing the resulting embryos. It is a well-established fertility preservation method.
Embryos may be created using partner sperm or, where appropriate and legally permitted, donor sperm. Before the procedure, patients should receive counseling about storage, future use, consent, and legal or ethical considerations.
3. Ovarian tissue freezing
Ovarian tissue freezing involves surgically removing and freezing ovarian tissue. It may be considered when there is not enough time for ovarian stimulation or when egg collection is not possible. It is also one of the main options for prepubertal girls.
In the future, the tissue may be transplanted back into the body in selected cases to restore ovarian function. This option is not suitable for every patient, especially when there is a risk that the ovarian tissue may contain cancer cells.
4. Ovarian suppression
In selected patients, especially in some breast cancer cases, medications may be used during chemotherapy to temporarily suppress ovarian function. This approach may help reduce the risk of ovarian damage, but it should not be considered a replacement for egg or embryo freezing. It is often used as an additional protective strategy.
5. Moving the ovaries away from radiation
For some patients who need pelvic radiotherapy, the ovaries may be surgically moved outside the radiation field. This is called ovarian transposition. The goal is to reduce radiation exposure to the ovaries.
6. Fertility-sparing surgery
In selected early-stage gynecologic cancers, surgery may sometimes be planned in a way that preserves fertility. This depends on cancer type, stage, risk of spread, and the patient’s desire for future pregnancy.
Fertility preservation options for males
1. Sperm freezing
Sperm freezing is the standard and most established method for postpubertal males. A semen sample is collected before cancer treatment begins, and sperm cells are frozen and stored. If possible, more than one sample may be collected.
Does sperm freezing take a long time?
Usually not. It can often be arranged quickly and does not significantly delay cancer treatment.
2. Surgical sperm retrieval
Some patients may be unable to provide a semen sample, or the sample may not contain enough sperm. In these cases, sperm may be retrieved surgically from the testicle. The retrieved sperm can be frozen and later used with in vitro fertilization and intracytoplasmic sperm injection.
3. Options for prepubertal boys
Before puberty, mature sperm production has not yet started. Therefore, standard sperm freezing is not possible. Testicular tissue freezing is still considered investigational and may only be available in selected centers or research settings.
Special considerations for children and adolescents
Fertility preservation in children and adolescents is medically, ethically, and emotionally sensitive. Decisions should involve the child or adolescent, parents or guardians, oncology team, fertility specialist, and, when needed, psychological support.
Information should be provided in an age-appropriate way. Future fertility may seem distant to a child, but it can become an important quality-of-life issue in adulthood.
Follow-up after cancer treatment
Reproductive health follow-up should continue after cancer treatment. The follow-up plan should be individualized.
For females, follow-up may include:
Monitoring menstrual function
Ovarian reserve testing
Assessment of early menopause symptoms
Counseling about the timing and safety of pregnancy
Referral for assisted reproductive technologies when needed
High-risk pregnancy evaluation if appropriate
For males, follow-up may include:
Semen analysis
Testosterone and hormone testing
Assessment of sexual function
Urology or andrology referral when needed
Counseling about future use of frozen sperm samples
When can pregnancy be considered after cancer treatment?
The timing depends on cancer type, treatment received, recurrence risk, medications, and overall health. This decision should always be made together with the oncology and reproductive medicine teams.
Is the same method suitable for every patient?
No. Fertility preservation must be individualized. Egg freezing may be the best option for one patient, while ovarian tissue freezing, embryo freezing, sperm freezing, surgical sperm retrieval, or careful follow-up may be more appropriate for another.
Important factors include:
Age
Pubertal status
Cancer type and stage
Urgency of treatment
Planned chemotherapy, radiotherapy, or surgery
Ovarian reserve or sperm parameters
Safety of future pregnancy
Personal, ethical, religious, and legal preferences
Cost and storage conditions
Practical questions patients can ask
Before cancer treatment begins, patients may ask their doctor:
Will my treatment affect my fertility?
Is the risk temporary or permanent?
Do I have time for fertility preservation?
Am I a candidate for egg, sperm, embryo, ovarian tissue, or testicular tissue freezing?
Will fertility preservation delay my cancer treatment?
Is the procedure safe in my situation?
How long can frozen samples be stored?
When can I consider pregnancy after treatment?
What tests will I need during follow-up?
Which specialist should I see for fertility counseling?
Conclusion
The primary goal of cancer treatment is to treat the disease effectively. However, long-term quality of life is also important, and reproductive health is a significant part of that quality of life.
Every child, adolescent, or adult with reproductive potential should be informed about fertility risks whenever possible before treatment begins. Appropriate patients should be referred promptly to a reproductive medicine specialist. A conversation held early may preserve an important possibility for the future.
This page is for general informational purposes only. Diagnosis, treatment, and fertility preservation decisions should always be made with an oncology team, reproductive medicine specialist, gynecologist, urologist/andrologist, and other relevant healthcare professionals.
