Oncofertility: Protecting Your Fertility Before Cancer Treatment Begins

Chemotherapy drugs target rapidly dividing cells. Since developing egg follicles and sperm-producing cells divide constantly, they are vulnerable to chemotherapy damage. The degree of fertility damage depends on the drug type, cumulative dose, patient age, and pre-treatment fertility status.

Alkylating agents (cyclophosphamide, busulfan, chlorambucil, melphalan, ifosfamide) are the most harmful to ovaries and testes – they cause direct DNA damage to primordial follicles and spermatogonial stem cells

Platinum-based agents (cisplatin, carboplatin) – moderate to high gonadotoxicity

Anthracyclines (doxorubicin) – moderate risk depending on cumulative dose

Taxanes (paclitaxel, docetaxel) – lower risk but not zero

Targeted therapies and immunotherapy – variable and still being studied; sperm banking is always advisable

Radiation effects depend on field, dose, and scatter. Pelvic radiation for cervical, uterine, rectal, bladder, or prostate cancers directly exposes the gonads and reproductive organs. Even low doses (6 to 8 Gy) can cause ovarian failure. Testicular damage is dose-dependent. Total body irradiation (TBI) used before bone marrow transplants causes permanent ovarian failure and severe testicular damage in almost all cases – one of the highest-risk scenarios in oncofertility.

Cranial radiation affecting the hypothalamus or pituitary – disrupts hormonal control of reproduction causing secondary hypogonadism

Spinal radiation – risk depends on field proximity to gonads

Scatter radiation from nearby fields – can reduce ovarian or testicular function even when gonads are not directly in the field

Bilateral oophorectomy – immediate surgical menopause and permanent loss of egg production

Hysterectomy – permanent loss of ability to carry pregnancy (eggs can still be frozen for gestational surrogacy)

Radical trachelectomy for cervical cancer – may preserve uterus but reduce cervical function needed for pregnancy

Bilateral orchiectomy – permanent loss of sperm production

Retroperitoneal lymph node dissection – may damage nerves controlling ejaculation, causing retrograde ejaculation or anejaculation

For women who have 8 to 14 days before cancer treatment begins, egg freezing is the most established and successful preservation option. The process is identical to an IVF stimulation cycle: injectable hormone medications to grow multiple follicles, follicle monitoring scans every 2 to 3 days, egg retrieval under IV sedation, and vitrification (ultra-rapid freezing) of mature eggs.

Women with male partners or willing to use donor sperm can freeze embryos instead of eggs. Embryos survive freezing and thawing at a marginally higher rate than unfertilised eggs. The stimulation and retrieval process is identical to egg freezing.

Embryo freezing requires partner or donor selection at this stage – if the relationship ends or the partner dies, the disposition of jointly-owned embryos requires both parties’ consent per clinic protocols. Single women or those uncertain about partners typically prefer egg freezing for flexibility.

For Urgent Cases: Involves surgically removing one ovary or strips of ovarian cortex through laparoscopy before cancer treatment. The tissue is frozen and stored. After recovery, it is re-implanted, restoring natural fertility for several years.

No stimulation required (can be done in 24-48 hrs).

The only option for prepubescent girls.

Caveat: risk of reintroducing cancer cells in haematological malignancies.

Using GnRH agonists during chemotherapy temporarily suppresses ovarian activity, potentially protecting follicles from chemotherapy damage. Evidence is mixed. This is considered an adjunctive strategy and should not replace egg or embryo freezing when either is feasible.

For pelvic radiation. Surgeons laparoscopically move the ovaries out of the radiation field (into the paracolic gutters). This reduces the ovarian radiation dose and can preserve function. Useful when eggs cannot be frozen before radiation.

treatment must begin within days; egg freezing usually not possible; sperm banking within 24 hours often achievable; ovarian tissue removal can sometimes be done at the same time as another necessary procedure

some allow only 7 to 10 days

often requires rapid treatment initiation

Reduced rates on egg freezing, embryo freezing, and sperm banking for confirmed cancer patients — contact us directly for current pricing.

Or reduction for cancer patients in active treatment.

Some patient-support organisations help cancer patients access fertility preservation.

Medication cost assistance for fertility preservation cycles.

Major fertility medication manufacturers offer free or reduced-cost medications for qualifying patients.

Many cancer centres can help identify assistance programmes — ask your oncology team.