Fertility preservation before medical treatment

On this page

1. Who may be at risk
2. Why timing matters
3. Options for women
4. Options for men
5. Questions to ask your care team

Fertility preservation means using medical, surgical and laboratory procedures to protect the ability of adults and children to conceive with their own eggs or sperm when their fertility is at risk.

Who may be at risk

People at risk of reduced fertility include:

• Women, men and children receiving chemotherapy, radiation or surgery for cancer
• People receiving chemotherapy and radiation before a bone marrow transplant, for example for relapsed Hodgkin or non-Hodgkin lymphoma, leukemia or sickle cell anemia
• People receiving chemotherapy for conditions other than cancer, such as lupus nephritis and other connective tissue disorders
• People who need their ovaries or testes removed, such as women with BRCA gene mutations who choose to remove both ovaries to reduce cancer risk, or women who need ovarian cysts removed
• People with chromosomal conditions linked to early loss of eggs, such as some patients with Turner syndrome

Without intervention, large studies of cancer survivors in the United States (the Childhood Cancer Survivor Study) and Scandinavia (the Norwegian Radium Hospital study) found these treatments can reduce the chance of conceiving biological children by 50% or more.

Why timing matters

The risk to fertility should be evaluated promptly, before treatment begins, by a reproductive endocrinologist experienced in fertility preservation. Women who ask about their fertility after cancer treatment are more likely to be referred to a fertility specialist, so it helps to raise the question early.

Regular periods and even normal blood tests, such as FSH, don’t accurately show whether cancer treatment has damaged the reproductive organs. Research by NYC IVF’s founder, Dr. Amr Azim, showed that even women with normal cycles and normal FSH levels after chemotherapy responded less to fertility medication and produced markedly fewer eggs. That is why eggs, sperm or embryos are ideally preserved before treatment. Anti-Müllerian hormone (AMH) appears to be a better indicator of ovarian reserve after chemotherapy.

Options for women

Embryo freezing

The ovaries are stimulated, eggs are retrieved and fertilized with sperm, and the resulting embryos are frozen. This is the standard and most established method of fertility preservation.

Egg freezing

Freezing eggs is an option for women who don’t have a partner and prefer not to use donor sperm. Rapid freezing (vitrification) gives better results than slow freezing. Learn more in our egg freezing article.

Ovarian tissue freezing

Ovarian tissue freezing is usually considered when treatment carries a very high risk of ovarian failure, when there isn’t time to stimulate the ovaries and freeze eggs or embryos, or for children. Part of the ovary is removed through laparoscopy (outpatient surgery), cut into thin slices and frozen. After treatment is complete, the tissue is thawed and transplanted back into the body.

Ovarian stimulation with estrogen-sensitive cancers

Estrogen-sensitive cancers include breast cancer, uterine cancer, thyroid cancer, melanoma and possibly some cancers of the brain and ovary. Breast cancer accounts for more than a quarter of cancers affecting women. Fertility medication normally raises estrogen levels significantly.

NYC IVF’s founder, Dr. Amr Azim, investigated using a special medication to prevent this rise in estrogen during stimulation. After intermediate follow-up of about two years, there was no apparent increase in breast cancer recurrence with this method. The study was published in the Journal of Clinical Oncology in 2008. A similar approach was used for endometrial cancer, published in Fertility and Sterility in 2007.

Options for men

Sperm freezing

Sperm freezing is the simplest and most established approach. One or more sperm samples are collected and frozen, then later thawed for insemination or IVF.

Testicular tissue freezing

Pieces of testicular tissue can be frozen for later use. Transplanting testicular tissue is still an investigational technique.

Questions to ask your care team

Your care will often involve several specialists. This checklist can help you organize what to ask and who to ask.

Your oncologist

• What type of cancer do I have, and what stage is it?
• What is my treatment plan? This may include:
  • Surgery
  • Chemotherapy
  • Bone marrow transplant
  • Radiation therapy
  • Hormonal treatment
• Is fertility preservation suitable for me?
• Can I have a referral letter?
• Can I have copies of my medical records, including surgery records, pathology reports, other tests (ER, PR, HER2/neu, BRCA) and general medical tests?

Your reproductive endocrinologist

• How are my cancer and its treatment expected to affect my future fertility?
• Which fertility preservation options suit me? These may include:
  • Embryo freezing
  • Egg freezing
  • Ovarian tissue freezing
  • Other options or a combination
• Is it safe?
• What happens to my frozen embryos, eggs or tissue after I’ve recovered?
• What are the chances of success with my options?
• Which tests do I need? These may include blood work (FSH, estradiol, AMH), ultrasound, semen analysis and other tests required for IVF and freezing.
• How will you coordinate the fertility preservation plan with my oncologist?

Support groups

Organizations such as Fertile Hope, the Young Survival Coalition and Living Beyond Breast Cancer can help with:

• Referrals
• Help with the cost of medication

This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.