If you’ve been diagnosed with cancer, your first thought might not be about fertility—but for people of childbearing age, it’s an important thing to consider before starting cancer treatment.
Many cancer therapies can affect your ability to have biological children later. Fortunately, there are oncofertility specialists that can walk you through ways to preserve your fertility before cancer treatment begins.
Female Oncofertility Options
For women, fertility preservation can take several forms, including egg freezing, embryo freezing, ovarian tissue cryopreservation, and ovarian transposition. Your oncology and fertility specialists will help determine which approach is safest and most effective based on your diagnosis, treatment plan, and how much time you have before cancer therapies begin.
Egg and Embryo Freezing
Egg and embryo freezing are the most established and widely used methods. They’re best suited for people with adequate ovarian reserve who can safely delay cancer treatment by about two to three weeks and whose cancers are not hormone-sensitive.
Whether pursuing egg freezing or embryo freezing, the process begins with injectable fertility medications that stimulate the ovaries to produce multiple mature eggs. Over roughly ten days, your doctor will monitor your progress through ultrasounds and bloodwork, adjusting medication as needed. Once the eggs are ready, you’ll take a trigger shot to prepare them for the egg retrieval. About 36 hours later, the eggs are collected during a brief outpatient procedure.
For egg freezing, mature eggs are frozen and stored for future use. For embryo freezing, the retrieved eggs are fertilized with sperm from a partner or donor, and the resulting embryos are allowed to develop for five to seven days before being frozen. Cancer patients are often fast-tracked through this process to minimize any delay in starting treatment.
Ovarian Tissue Cryopreservation (OTC)
When egg or embryo freezing isn’t safe or feasible—such as in cases of hormone-sensitive cancer or when cancer treatment must begin immediately—ovarian tissue cryopreservation (OTC) may be recommended. This involves removing part or all of one ovary through a laparoscopic procedure and freezing the tissue, which contains thousands of immature eggs. Later, when cancer treatment is complete and it’s medically appropriate, the tissue can be thawed and reimplanted to restore hormone production and possibly fertility.
Cryopreserved ovarian tissue has been shown to have the potential to create healthy pregnancies and live births, prompting organizations such as the American Society for Reproductive Medicine (ASRM) to remove its “experimental” designation.
OTC is most often recommended for patients who must begin cancer treatment immediately, for those who can’t take the hormone medications required for egg or embryo freezing, and for prepubertal patients who are not yet candidates for traditional fertility preservation methods.
Ovarian Transposition
Another approach, ovarian transposition, may be suggested when radiation to the pelvic area is planned. In this procedure, the ovaries are surgically moved to another location within the abdomen, away from the radiation field, to protect them from damage.
This procedure allows the ovaries to remain in your body, which enables the normal hormonal cycles to continue. Typically, patients who undergo ovarian transposition require assisted reproductive technology like IVF to conceive following ovarian transposition.
Note: With ovarian transposition, the ovaries are spared from pelvic radiation, but are still exposed to other cancer treatments like chemotherapy and other medications.
Male Oncofertility Options
For men facing a cancer diagnosis, protecting fertility is just as important as it is for women. The standard and most widely used method is sperm freezing, also called sperm cryopreservation, though there are other methods in the experimental phase.
Sperm Freezing
The sperm freezing process is simple: semen samples are collected through masturbation, usually for a total of three to four samples collected over several days, each sample being frozen for future use. It may be ideal to have multiple frozen semen samples, but even a single sample can be valuable to your future fertility.
If you can’t ejaculate, other medical options called electroejaculation and testicular sperm extraction (TESE) can aid in collecting a sperm sample. Electroejaculation uses gentle electrical nerve stimulation to trigger ejaculation, while TESE is a minor surgical procedure that retrieves sperm directly from the testes. For all of these sperm collection methods, the collected sperm can later be thawed and used in fertility treatments such as intrauterine insemination (IUI) or IVF to try to conceive.
Testicular Tissue Cryopreservation
Testicular tissue cryopreservation is an experimental method of fertility preservation used for adult males and is now being offered to pre-pubescent male cancer patients as well. In testicular tissue cryopreservation, testicular tissue is surgically removed and frozen for future use, with the goal of extracting sperm from it or developing sperm from immature cells when needed.
According to Memorial Sloane Kettering Cancer Center, testicular tissue cryopreservation is currently considered an experimental procedure and no babies have been born as a result. The hope is that scientists will discover a way to use this tissue to produce sperm in the future.
Fertility preservation is an important part of comprehensive cancer care. Your oncology and fertility teams will work together to identify the options that best fit your diagnosis and treatment timeline, coordinating care to ensure your cancer therapy stays on track. Taking steps to preserve your fertility now can help protect your future family-building goals.