© 2005-2012 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.
This section has been reviewed and approved by the Cancer.Net Editorial Board, 1/2013
Key Messages:
- If you are worried your treatment plan will affect your fertility (ability to have children), talk with a member of your health care team before treatment begins.
- There are a number of ways to preserve fertility in both men and women.
- Physical, economic, and ethical factors may affect your fertility preservation options.
It is important to discuss the potential fertility-related side effects of your treatment plan with your health care team, as well as what steps you might be able to take to preserve your fertility, before treatment begins. Age, gender, physical and sexual maturation, and, in some cases, relationship status (for example, whether a woman currently has a partner) affect the options available for fertility preservation. Your doctor and/or a reproductive endocrinologist (a doctor who specializes in fertility issues) can help you learn about your options.
Unfortunately, not all of these options are available or appropriate for everyone. Fertility-preserving procedures may be stressful during an already difficult time, and their effectiveness may vary based on a number of factors. Many options, including in vitro fertilization (a process that involves collecting a woman's eggs and fertilizing them with sperm outside her body, for the purpose of later transferring the embryo back into her body for it to develop, IVF) and embryo cryopreservation (freezing fertilized eggs for later reimplantation), may be costly. In addition, some people may have ethical questions about various options, so it is important to talk with your doctor to find the information you need to make the best decision. You may also consider speaking with a counselor for guidance about these decisions.
Learn more about ASCO’s recommendations for preserving fertility.
Fertility-preserving options for men
Protecting the testes from radiation therapy. In men, it is possible to shield the testes from radiation and prevent sperm damage if the cancer is located in another part of the pelvis.
Sperm cryopreservation (sperm banking). This procedure involves freezing and storing semen for use in IVF procedures. It is an option for most males who have gone through puberty.
Testicular-tissue cryopreservation and reimplantation. This investigational option involves removing, freezing, and storing testicular tissue before treatment begins. This tissue is then thawed and surgically put back into the body once treatment has finished. Although research studies have shown this is possible, the procedure has not been done in patients yet.
Fertility-preserving options for women
Protecting the ovaries from radiation therapy. For women whose treatment plan includes radiation therapy focused on the pelvis, it is often difficult to protect the ovaries from damage. If both ovaries receive radiation treatment, infertility may be permanent. However, in many cases, both ovaries do not receive radiation treatment so any resulting fertility issues may be less severe. An option that may be considered is oophoropexy, which involves surgically moving one or both ovaries out of the reach of the radiation treatment and then returning them once treatment has finished. However, this method is effective only about 50% of the time.
Embryo cryopreservation. Embryo cryopreservation is the most successful and established method of fertility preservation for women. It requires about two weeks of fertility drug treatment before eggs are harvested for use in IVF. The resulting embryos are then frozen until the woman is ready to become pregnant. Even though fertility drug treatment increases estrogen levels, this procedure is still an option for women with estrogen-sensitive cancers, as doctors can use drugs called aromatase inhibitors to keep estrogen levels low. Some ethical issues, such as what to do with any unused fertilized embryos, arise with this technique and require careful discussion and consideration.
Oocyte (unfertilized egg) cryopreservation. As part of this approach, unfertilized eggs are taken from the ovaries after about two weeks of fertility drug treatment and frozen. Although this procedure may pose fewer ethical issues than freezing embryos, it is slightly less successful than embryo freezing.
Ovarian tissue preservation. This is a relatively new, investigational approach to fertility preservation. It requires the surgical removal and freezing of ovarian tissue before it is transplanted back into the woman after she has finished cancer treatment. This procedure may be the only option for young girls who cannot undergo oocyte or embryo freezing for practical reasons.
Fertility-preserving surgery. Recent research shows that women with cervical cancer who have surgery to remove the cervix while keeping the uterus intact may become pregnant. In such cases, the baby would be delivered by cesarean section. Some women with ovarian cancer can also have surgery to remove the cancer and still preserve their fertility. The cancer must be small, located in only one ovary, and have a low risk of growing and spreading. In these cases the surgeon will remove just the ovary with cancer, leaving one healthy ovary and the uterus in place.
Questions to ask the doctor
It is important to talk with your doctor as early as possible about how cancer treatment may affect your fertility. Most of the fertility-preserving options discussed above need to take place before cancer treatment begins.
Consider asking your doctor or another member of your health care team the following questions:
- Could my treatment plan affect my ability to have children in the future?
- Should I talk with a fertility specialist or a reproductive endocrinologist before starting treatment?
- What options do I have to preserve my fertility?
- Will any of these options postpone the start of my treatment? If so, what effect could this delay have on my prognosis (chance of recovery)?
- Are there any other options for preserving my fertility?
- Will any of these fertility preservation methods make my cancer treatment(s) less effective?
- Do any of these fertility preservation options increase the risk that the cancer may come back?
- Where can I find support for coping with fertility issues?
More Information
Fertility and Cancer Treatment
Preserving Fertility in Children With Cancer
Moving Forward Videos: Fertility for Young Adults with Cancer
Additional Resources