AYA Fertility Preservation Before Cancer Treatment

Many cancer treatments can affect your ability to have biological children later. The best time to protect that possibility is before treatment starts — before the first dose of chemotherapy, the first radiation session, or surgery. Once treatment begins, some options narrow or close.

The timing is brutal. You do not have to want children right now — only to decide whether to keep the option open.

Ask your oncology team directly: "Could this treatment affect my fertility, and can I see a fertility specialist before we start?"

The specialist you want is a reproductive endocrinologist (REI), or an oncofertility program if your center has one. Ask your oncologist, nurse navigator or social worker to refer you. These referrals are urgent, and many centers arrange a consultation within a few days. If nobody has raised fertility with you, raise it yourself — parents can ask on a teenager's behalf. ASCO advises clinicians to raise this as early as possible and to refer anyone interested or unsure. NCI notes that survivors had less regret after seeing a fertility specialist, whether or not they preserved anything.

Risk is real but not uniform. It depends on the drug, the total dose, the radiation field, your age and your sex — often no one can give you an exact number, only a range.

Higher risk:

• Alkylating agents — cyclophosphamide, ifosfamide, busulfan, melphalan and similar drugs. They damage sperm-forming cells and the follicles that hold eggs. Risk rises with higher cumulative doses and with drug combinations.
• Radiation to the pelvis, testicles, abdomen, or brain and pituitary, and total body irradiation, usually part of a stem cell transplant.
• Surgery that removes reproductive organs, or that leaves scar tissue in the pelvis.
• Some hormone therapies.

The effects of many targeted therapies and immunotherapies are still being studied. "Not yet known" is not "safe" — ask anyway.

Age matters too: someone treated at 38 starts with a smaller ovarian reserve than someone treated at 17. Younger patients more often recover function, but recovery is never guaranteed, and periods returning does not promise a normal span of reproductive years.

Sperm banking is the fastest option, for anyone past puberty. You give one or more semen samples, which are checked and frozen — often the same day or the same week. Even a single sample is worth banking, and frozen sperm lasts for decades. ACS notes it is about as likely to start a pregnancy as sperm from men who never had cancer. If you cannot produce a sample, ask about surgical retrieval.

Egg (oocyte) and embryo freezing require ovarian stimulation: roughly two weeks of injections and monitoring, then a short retrieval (ACS describes about 2 to 3 weeks overall). You usually do not have to wait for your next period — random-start protocols begin stimulation at any point in the cycle, and ASRM's 2026 committee opinion says they cause negligible delay with similar outcomes. Freezing eggs needs no sperm source now and keeps them under your sole control; embryos give somewhat more predictable outcomes but raise questions about who controls them later.

Ovarian tissue freezing removes ovarian tissue surgically and freezes it for possible transplant later. It needs no stimulation, so it can happen within days, and it is the main option for girls who have not reached puberty. ASRM no longer considers it experimental. Ask whether your center performs it, and whether reintroducing cancer cells is a concern for your diagnosis.

Testicular tissue freezing is for prepubertal boys, who cannot yet make mature sperm. It is still experimental — ASRM calls it investigational, offered only under IRB-approved research protocols. Ask whether a study is open near you.

Ovarian transposition and shielding. Surgery can move the ovaries out of a radiation field; ACS notes it works about half the time, partly because of scattered radiation and because ovaries can drift back. Lead shielding can reduce scatter to the testicles during pelvic radiation, but not when the radiation must target them directly.

GnRH agonists temporarily quiet the ovaries during chemotherapy. The evidence is mixed. ASRM says they may be offered, particularly in breast cancer, to reduce the risk of premature ovarian insufficiency — but states plainly that they should not replace egg or embryo freezing. Treat them as a possible add-on, never as your plan.

ACS puts egg or embryo freezing above $10,000 plus annual storage, and sperm banking at roughly $500 to $1,000 plus about $200 to $500 a year.

• Livestrong Fertility works with partner clinics offering discounted preservation and provides free stimulation medication to approved applicants. Income limits apply and you need a short letter from your oncologist, so apply early.
• State insurance mandates. A growing number of states require some coverage for fertility preservation when infertility is caused by medical treatment — iatrogenic infertility. Rules vary widely and usually do not reach self-funded employer plans. Ask your center's financial navigator to check your plan; do not assume either way.

You have not run out of options.

• Ask for a fertility referral anyway. Some options remain possible between cycles or after treatment ends.
• Afterward, get tested rather than assuming — a semen analysis for men; AMH, antral follicle count and a cycle history for women. Many people still have usable sperm or eggs and can bank then.
• Many people who preserve nothing go on to have biological children. Preservation is insurance, not a requirement.
• If your own eggs or sperm are not usable, donor eggs, donor sperm, donor embryos, gestational surrogacy, fostering and adoption are all real routes to a family.
• Do not assume you are infertile in the meantime. Contraception still matters; ask how long to wait before trying to conceive.

• Could this plan affect my fertility, and how much, given my exact drugs and doses?
• Can I safely delay treatment, and by how long?
• Can I see a reproductive endocrinologist this week?
• Which preservation options fit the time I actually have?
• Do you offer ovarian or testicular tissue freezing here — as standard care or as a research study?
• Can my ovaries be moved, or my testicles shielded, before radiation?
• What will this cost, and who can help me with Livestrong Fertility and my insurance?
• Who follows my fertility after treatment ends, and what contraception should I use meanwhile?

Not everyone can preserve fertility. Sometimes the cancer is too aggressive to delay even a week; sometimes the money is not there. That is not a failure, and it does not mean you cannot become a parent. What you can control is asking early.

This page is general education, not medical advice.

• https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-men
• https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women
• https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-preservation-in-patients-with-medical-indications-a-committee-opinion-2026/
• https://www.fertstert.org/news-do/asrm-removes-experimental-label-ovarian-tissue-cryopreservation-otc-pediatric-research
• https://ascopubs.org/doi/10.1200/JCO-24-02782
• https://www.asco.org/about-asco/press-center/news-releases/asco-updates-clinical-practice-guidelines-fertility-preservation
• https://www.cancer.org/cancer/side-effects/fertility/preserving-fertility-in-women.html
• https://www.cancer.org/cancer/side-effects/fertility/preserving-fertility-in-men.html
• https://www.cancer.org/cancer/side-effects/fertility/preserving-fertility-in-children-and-teens-with-cancer.html
• https://livestrong.org/how-we-help/livestrong-fertility/
• https://livestrong.org/resources/fertility-and-insurance/
• https://nashp.org/states-add-coverage-mandates-to-cover-infertility-treatment-following-cancer-treatments/