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Fertility Preservation Before Cancer Treatment
Fertility preservation is one of the few cancer decisions that has a closing door on it. Most of these options only work if they are done before treatment starts, because the same chemotherapy or radiation that treats the cancer can damage the eggs, the sperm, or the glands that control them.
The National Cancer Institute puts the timing plainly: if having a biological child one day may be important to you, consider talking with your doctor and a fertility specialist before starting cancer treatment. Your care team decides whether a short delay is safe for your particular cancer. Some cancers can wait a few weeks. Some cannot.
Which treatments raise the risk
NCI describes fertility changes as either temporary or permanent, depending on the treatment type, the dose, how long it lasts, your age, your fertility before diagnosis, and where the cancer is.
- Chemotherapy, especially the alkylating agents, is the group most likely to harm egg-producing and sperm-producing cells. Higher doses and multiple drugs together raise the risk.
- Radiation therapy to the pelvis, the reproductive organs, or the central nervous system can damage the ovaries or testicles. Proton beam and intensity-modulated radiation may cause less harm than standard radiation.
- Surgery that removes reproductive organs causes permanent infertility. Abdominal or pelvic surgery can leave scar tissue.
- Stem cell transplant involves high-dose chemotherapy or radiation beforehand, which can damage ovaries or sperm-forming cells.
- Hormone therapy can lower sperm counts or stop ovarian function.
- Targeted therapy and immunotherapy are still being studied. Some tyrosine kinase inhibitors may lower fertility. This is an area where the evidence is genuinely thin, and NCI says so.
Options if you have ovaries
Egg freezing and embryo freezing both start with hormone injections to stimulate the ovaries, then a procedure to retrieve mature eggs. Eggs can be frozen on their own, or fertilized with sperm in a lab and frozen as embryos. The American Cancer Society states that the stimulation step "can take 2-3 weeks for this to work." That two-to-three-week window is the main scheduling pressure you and your oncologist have to solve.
Ovarian tissue freezing removes egg-containing tissue surgically through a laparoscope, to be thawed and put back later. It does not need hormone stimulation, so it suits people who cannot delay treatment, cannot take hormonal medicines, or have not gone through puberty.
Ovarian transposition surgically moves the ovaries away from the radiation field. ACS says it is "usually best to do the procedure just before you start radiation therapy" and that it is "successful about half of the time."
Ovarian shielding places lead shields over the ovaries during radiation. Radical trachelectomy removes the cervix but preserves the uterus for some early-stage cervical cancers. GnRH agonists shut down ovarian function during treatment.
Options if you have testicles
Sperm banking is the most common approach after puberty. Samples are collected, tested for count and movement, then frozen. Collection is usually by masturbation, but penile vibratory stimulation, electroejaculation, or collection from urine can be used when that is not possible.
TESE and TESA remove sperm directly from testicular tissue with surgery or a needle, for people who cannot produce a semen sample or have a blockage. Testicular tissue freezing for boys before puberty is still experimental, with clinical trials ongoing. Testicular shielding protects the testicles from scatter radiation.
Sperm banking is fast compared with egg retrieval, which matters if treatment starts within days. ACS notes that some people with fast-growing cancers such as acute leukemia may be too ill to produce samples at all.
What it costs
ACS gives these figures: freezing eggs or embryos costs "$10,000 or more, not including storage fees," while sperm banking runs "about $500-$1000" with storage "about $200-$500 per year." Some insurance plans cover part of it, and states differ in whether they require coverage. NCI points to the Oncofertility Consortium, the Alliance for Fertility Preservation, and Livestrong Fertility for information, state coverage rules, and financial help. Ask whether your hospital has a patient navigator.
One more thing before treatment
Fertility can drop without disappearing. NCI notes there may still be a chance of pregnancy during treatment, and that some cancer treatments can be harmful or cause a miscarriage, so your doctor may recommend birth control or condoms while you are being treated.
If you decide not to preserve fertility, that is a legitimate choice. NCI notes survivors were less regretful if they had met with a fertility specialist, whichever way they decided.
Sources
- National Cancer Institute: Fertility Issues in Girls and Women with Cancer. https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women
- National Cancer Institute: Fertility Issues in Boys and Men with Cancer. https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-men
- American Cancer Society: Preserving Your Fertility When You Have Cancer. https://www.cancer.org/cancer/side-effects/fertility/preserving-fertility-in-women.html
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