Fertility Preservation Before Cancer Treatment

Before undergoing cancer treatment, children, men, and women can preserve their reproductive potential through fertility preservation technologies.

Fertility Preservation for Men

Before beginning cancer treatments like chemotherapy or radiation, a man can provide semen samples for sperm cryopreservation (freezing) at a fertility center or sperm bank for later use. More than one sample separated by 48 hours is recommended as the body’s response to cancer can result in a lower than normal sperm count. Sperm can be frozen for years then thawed for use in intrauterine insemination (IUI) if the sperm count is adequate, or in vitro fertilization (IVF) if the sperm count is low. In cases of severely low sperm count, intracytoplasmic sperm injection (ICSI) may be necessary.

Fertility Preservation for Women

If there is an adequate amount of time before cancer treatment begins, a woman can undergo ovarian stimulation to retrieve as many eggs as possible to cryopreserve (freeze) for future use. The eggs can also be fertilized using IVF if she desires to freeze embryos. Frozen eggs and embryos can be stored for many years. Timing of fertility and cancer treatments is important, since the duration of a stimulation cycle may delay cancer treatment by an average of 12 days. The expense of ovarian stimulation or IVF in conjunction with upcoming cancer treatment should also be considered.

If cancer in or near the pelvis will be treated by radiation, the woman’s ovaries may be surgically repositioned further away from the radiation target area (oophoropexy), reducing risk to the eggs. Current techniques also include removing and freezing the ovarian tissue to preserve fertility if there is no time for ovarian stimulation.

Fertility Preservation for Children

If a child is diagnosed with cancer or other infertility-causing disease, the parents may request fertility preservation for their child. This requires consulting with an oncologist and member of the fertility preservation team to ensure this would benefit the child. The child must agree with the decision to move forward with fertility preservation procedures, which may include standard fertility treatments if the child is of reproductive age, or possible cryopreservation (freezing) of ovarian or testicular tissue if the child is not of reproductive age.

Post-Mortem Sperm or Embryo Use

If a couple chooses to cryopreserve sperm or embryos, but the male partner battling cancer does not survive, the woman is left with the difficult decision of trying for a pregnancy using intrauterine insemination (IUI), in vitro fertilization (IVF), donating the frozen sperm or embryos, or disposing of them. If the female partner does not survive cancer and she and her partner created and froze embryos, the man will also face a similar decision. This choice is emotionally difficult and may require professional counseling in addition to legal consent.

Detailed instructions about what to do with stored sperm, eggs, or embryos should be given before undergoing cancer or other disease treatments. If the patient preserves reproductive tissue but passes away, his or her reproductive cells cannot be used to achieve a pregnancy unless he or she specifically gave permission for their use.