AYA Fertility Preservation Before Cancer Treatment

This page is for teens and young adults facing cancer treatment, and for their parents. It explains how to protect the chance of having biological children later.

Many cancer treatments can affect your ability to have biological children later. The best time to protect that possibility is before treatment starts. That means 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. You only have 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). An oncofertility program works too, if your center has one. Ask your oncologist, nurse navigator or social worker to refer you. Ask for the referral before treatment starts, and say that time matters.

If nobody has raised fertility with you, raise it yourself. Parents can ask on a teenager's behalf. NCI notes that survivors had less regret after seeing a fertility specialist, whether or not they preserved anything.

Risk is real, but it is not the same for everyone. 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.

Higher risk:

• Alkylating agents — cyclophosphamide, ifosfamide, busulfan, melphalan and similar drugs. NCI calls alkylating agents high risk because they can stop eggs from maturing.
• 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.

Once you know your risk, the next question is which options fit the time you have.

Sperm banking is the most common option for people who have been through puberty. You give semen samples, which are frozen. Even a single sample can be valuable, and ACS says 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. Banking is not possible for everyone, for example when a fast-growing cancer needs treatment right away.

Egg (oocyte) and embryo freezing require ovarian stimulation. ACS says stimulation can take 2 to 3 weeks before the eggs are retrieved. Eggs are frozen on their own or fertilized and frozen as embryos. Ask your specialist how soon it can start and how it fits your cancer treatment.

Ovarian tissue freezing removes ovarian tissue surgically and freezes it for possible transplant later. NCI says it suits girls before puberty and people who cannot delay treatment. ACS calls it the most established option for girls before puberty. Ask whether your center offers it.

Testicular tissue freezing is for prepubertal boys, who cannot yet make mature sperm. NCI says it is available through clinical trials, and ACS calls it experimental. 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. ACS links this to scattered radiation. For the testicles, NCI describes a protective cover that shields them from scatter during pelvic radiation. ACS says shielding cannot help when both testicles need direct radiation.

GnRH agonists are medicines sometimes used to shut down the ovaries during cancer treatment. ACS says some studies suggest they may not work well. Ask your team whether they apply to you, and do not treat them as a replacement for other options.

ACS says egg or embryo freezing can cost $10,000 or more, not counting storage fees. It puts sperm banking at roughly $500 to $1,000, plus about $200 to $500 a year.

• Financial help. NCI and ACS both point to Livestrong Fertility for financial help and clinic listings. Ask the program what it offers now.
• Insurance. NCI says many states require insurance coverage for some fertility care, and ACS says some plans cover part of sperm banking. 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, ask about fertility testing rather than assuming. Your team can tell you which tests fit you.
• Preservation is a way to keep options open, not a requirement for becoming a parent.
• If your own eggs or sperm are not usable, other routes to a family are still real. They include donor eggs, donor sperm, donor embryos, gestational surrogacy, fostering and adoption.
• Do not assume you are infertile in the meantime. Ask your team about birth control and how long to wait before trying to conceive.

• Could this plan affect my fertility, and how much, given my exact drugs and doses?
• Can treatment safely wait, and for 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 financial programs and my insurance?
• Who follows my fertility after treatment ends, and what birth control 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.

Egg and embryo freezing involve stimulating the ovaries, which can sometimes cause ovarian hyperstimulation syndrome (OHSS). Retrieval and tissue-freezing surgery carry the usual risks of any procedure. Contact the fertility clinic, not only your oncology team, since they know what your ovaries were doing this week.

• Call 911 or go to an emergency department if you cannot catch your breath, your belly is tight and rapidly swelling, or you have pain and swelling in one calf. Chest pain, coughing blood, or fainting after an egg retrieval also mean go now. Do not drive yourself.
• Call your fertility clinic the same day if you have any of these: you gain more than about two pounds in a single day, you are passing far less urine than usual, or vomiting is stopping you keeping fluids down. Steadily worsening bloating with abdominal pain after stimulation belongs in this group.
• Call your fertility clinic within a day or two if mild bloating or nausea after your injections is not settling, an injection site becomes red and sore, or light spotting after retrieval turns heavier.

If any of this happens, say clearly that you are mid-cycle for fertility preservation before cancer treatment. It changes how quickly you are seen.

• National Cancer Institute — Male Fertility and Cancer Treatment
• National Cancer Institute — Female Fertility and Cancer Treatment
• 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