Fertility preservation is a type of procedure used to help keep a person’s ability to have children. A fertility preservation procedure is done before a medical treatment that may cause infertility, such as radiation therapy or chemotherapy. Examples of fertility preservation procedures include sperm banking, egg freezing, in vitro fertilization with embryo freezing, and certain types of surgery for cervical and ovarian cancer.

People with certain diseases, disorders, and life events that affect fertility may benefit from fertility preservation. These include people who:

• Have been exposed to toxic chemicals in the workplace or during military duty
• Have endometriosis
• Have uterine fibroids
• Are about to be treated for cancer
• Are about to be treated for an autoimmune disease, such as lupus
• Have a genetic disease that affects future fertility
• Delay having children

A number of fertility-preserving options are available.

Fertility-preserving options for males include:

• Sperm cryopreservation (pronounced krahy-oh-prez-er-VEY-shuhn). In this process, a male provides samples of his semen. The semen is then frozen and stored for future use in a process called cryopreservation.
• Gonadal shielding. Radiation treatment for cancer and other conditions can harm fertility, especially if it is used in the pelvic area. Some radiation treatments use modern techniques to aim the rays on a very small area. The testicles can also be protected with a lead shield.

Fertility-preserving options for females include:

• Embryo cryopreservation. This method, also called embryo freezing, is the most common and successful option for preserving a female's fertility. First, a health care provider removes eggs from the ovaries. The eggs are then fertilized with sperm from her partner or a donor in a lab in a process called in vitro fertilization. The resulting embryos are frozen and stored for future use.
• Oocyte (pronounced OH-uh-sahyt) cryopreservation. This option is similar to embryo cryopreservation, except that unfertilized eggs are frozen and stored.
• Gonadal shielding. This process is similar to gonadal shielding for males. Steps are taken, such as aiming rays at a small area or covering the pelvic area with a lead shield, to protect the ovaries from radiation.
• Ovarian transposition. A health care provider performs a minor surgery to move the ovaries and sometimes the fallopian tubes from the area that will receive radiation to an area that will not receive radiation. For example, they may be relocated to an area of the abdomen wall that will not receive radiation.

Some of these options, such as sperm, oocyte, and embryo cryopreservation, are available only to males and females who have gone through puberty and have mature sperm and eggs. However, gonadal shielding and ovarian transposition can be used to preserve fertility in children who have not gone through puberty.

If you have questions about fertility preservation, talk with your health care provider.

Many cancer treatments can affect a boy’s or a man’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may lower fertility or cause infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not your fertility is affected depends on factors such as:

• your baseline fertility
• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since treatment
• other personal health factors

It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment if at all possible. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility?
• Are there other recommended cancer treatments that might not cause fertility problems?
• Which fertility preservation options would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist (such as a reproductive endocrinologist) that I could talk with to learn more?
• Is condom use advised, based on the treatment I’m receiving?
• Is birth control also recommended?
• What are the chances that my fertility will return after treatment?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your healthcare team to learn what to expect based on your treatment(s):

• Chemotherapy (especially alkylating drugs) can damage sperm in men and sperm-forming cells (germ cells) in young boys.
• Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
• Radiation therapy to the reproductive organs as well as radiation near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility. Radiation may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can damage the pituitary gland and decrease the production of testosterone and sperm. For some types of cancers, the testicles can be protected from radiation through a procedure called testicular shielding.
• Surgery for cancers of the reproductive organs and for pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.
• Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants, involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment, such as immunotherapy and targeted cancer therapy, may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some men, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and learning about options to preserve their fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

Fertility Preservation Options for Boys and Men

Men and boys with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

• Sperm banking (also called semen cryopreservation) is the most common and easy option for young men of reproductive age who would like to have children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time.
• Testicular shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.
• Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample. Sperm is collected through a medical procedure and frozen for future use.
• Testicular tissue freezing (also called testicular tissue cryopreservation) is still considered an experimental procedure at most hospitals. For boys who have not gone through puberty and are at high risk of infertility, this procedure may be an option.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation procedures whenever possible.

Many cancer treatments can affect a girl’s or woman’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may increase the risk of, or cause, infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not fertility is affected depends on factors such as:

• your baseline fertility
• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since cancer treatment
• other personal health factors

It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment, whenever possible. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility? Could treatment make it difficult to become pregnant or carry a pregnancy in the future?
• Are there other recommended cancer treatments that might not cause fertility problems?
• Which fertility option(s) would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist (such as a reproductive endocrinologist) who I could talk with to learn more?
• Is condom use advised, based on the treatment I’m receiving?
• Is birth control recommended?
• After treatment, what are the chances that my fertility will return? How long might it take for my fertility to return?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your health care team to learn what to expect, based on your treatment(s):

• Chemotherapy (especially alkylating agents) can affect the ovaries, causing them to stop releasing eggs and estrogen. This is called primary ovarian insufficiency (POI). Sometimes POI is temporary and your menstrual periods and fertility return after treatment. Other times, damage to your ovaries is permanent and fertility doesn’t return. You may have hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. Chemotherapy can also lower the number of healthy eggs in the ovaries. Women who are closer to the age of natural menopause may have a greater risk of infertility. The National Institute for Child Health and Human Development (NICHD) has more information about primary ovarian insufficiency.
• Radiation therapy to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Some organs, such as the ovaries, can often be protected by ovarian shielding or by oophoropexy—a procedure that surgically moves the ovaries away from the radiation area. Radiation therapy to the brain can also harm the pituitary gland. This gland is important because it sends signals to the ovaries to make hormones such as estrogen that are needed for ovulation. The amount of radiation given and the part of your body being treated both play a role in whether or not fertility is affected.
• Surgery for cancers of the reproductive system and for cancers in the pelvis region can harm nearby reproductive tissues and cause scarring, which can affect your fertility. The size and location of the tumor are important factors in whether or not fertility is affected.
• Hormone therapy (also called endocrine therapy) used to treat cancer can disrupt the menstrual cycle, which may affect your fertility. Side effects depend on the specific hormones used and may include hot flashes, night sweats, and vaginal dryness.
• Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment such as immunotherapy and targeted cancer therapy may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some women, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. While it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and about options to preserve fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

Fertility Preservation Options for Girls and Women

Women and girls with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

• Egg freezing (also called egg or oocyte cryopreservation) is a procedure in which eggs are removed from the ovary and frozen. Later the eggs can be thawed, fertilized with sperm in the lab to form embryos, and placed in a woman’s uterus. Egg freezing is a newer procedure than embryo freezing.
• Embryo freezing (also called embryo banking or embryo cryopreservation) is a procedure in which eggs are removed from the ovary. They are then fertilized with sperm in the lab to form embryos and frozen for future use.
• Ovarian shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body, over the ovaries and other parts of the reproductive system, to shield them from scatter radiation.
• Ovarian tissue freezing (also called ovarian tissue cryopreservation) is still considered an experimental procedure, for young girls who haven’t gone through puberty and don’t have mature eggs. It involves surgically removing part or all of an ovary and then freezing the ovarian tissue, which contains eggs. Later, the tissue is thawed and placed back in a woman. Although pregnancies have occurred as a result of this procedure, it’s only an option for some types of cancer.
• Ovarian transposition (also called oophoropexy) is an operation to move the ovaries away from the part of the body receiving radiation. This procedure may be done during surgery to remove the cancer or through laparoscopic surgery.
• Radical trachelectomy (also called radical cervicectomy) is surgery used to treat women with early-stage cervical cancer who would like to have children. This operation removes the cervix, nearby lymph nodes, and the upper part of the vagina. The uterus is then attached to the remaining part of the vagina, with a special band that serves as the cervix.
• Treatment with gonadotropin-releasing hormone agonist (also called GnRHa), a substance that causes the ovaries to stop making estrogen and progesterone. Research is ongoing to assess the effectiveness of giving GnRHa to protect the ovaries.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation, whenever possible.