Fertility Preservation Before Cancer Treatment: What You Need to Know Now

If you’ve just been diagnosed with cancer and you’re of reproductive age, this article is written for you—and it’s written with urgency, because time matters. Many cancer treatments (chemotherapy, radiation to the pelvic area, and certain surgeries) can damage or destroy your fertility. But if you act before treatment begins, fertility preservation options exist that can give you a chance at biological parenthood after you’re cancer-free.

This is not a decision you have to make alone, and it doesn’t have to delay your cancer treatment significantly. But it does require a conversation with your oncologist now—ideally before your first treatment session—and a referral to a reproductive endocrinologist who specializes in oncofertility.

Why Cancer Treatment Threatens Fertility

Chemotherapy is the most common threat. Alkylating agents (cyclophosphamide, ifosfamide, busulfan, melphalan) are the most gonadotoxic—meaning they cause the most damage to eggs and sperm. Other chemotherapy classes carry lower but still meaningful risk. The degree of damage depends on the specific drugs, the dosage, your age, and your pre-treatment ovarian reserve or sperm parameters.

Radiation to the pelvis, abdomen, or total body irradiation (used in bone marrow transplant preparation) can directly damage ovarian tissue or testicular function. The risk depends on the radiation field and dose.

Surgery that removes one or both ovaries, the uterus, or one or both testes directly eliminates or reduces reproductive capacity.

Some of this damage is dose-dependent and potentially reversible. Some is permanent. Your oncologist can tell you the specific gonadotoxicity risk of your treatment protocol, and this information should drive the urgency of your fertility preservation decision.

Preservation Options for People With Ovaries

Egg Freezing (Oocyte Cryopreservation)

This is the most established option. You undergo an abbreviated IVF stimulation protocol (typically 10–14 days of injectable hormones), followed by an egg retrieval procedure. The retrieved eggs are vitrified (flash-frozen) and stored for future use. When you’re ready, the eggs can be thawed, fertilized, and transferred.

Modern oncofertility protocols can often begin within days of a cancer diagnosis and be completed in under two weeks—a timeline that is compatible with most cancer treatment schedules. “Random start” stimulation protocols allow egg freezing to begin at any point in your menstrual cycle, eliminating the historical need to wait for the start of your next period.

Cost: $5,000 to $15,000 for the stimulation and retrieval, plus $500 to $1,000 per year for storage. Many cancer-specific programs offer discounted or free fertility preservation. Livestrong Fertility, the SAMFund, and the Alliance for Fertility Preservation maintain lists of financial assistance programs. California’s SB 729 now mandates coverage of medically necessary fertility preservation for patients with cancer on qualifying plans.

Embryo Freezing

Same process as egg freezing, but the eggs are fertilized with partner or donor sperm before freezing. Frozen embryos have slightly higher survival rates upon thawing than frozen eggs, but this option requires either a partner or a decision about sperm donor at a time when you may not be ready to make that choice. For many young cancer patients, egg freezing provides more flexibility.

Ovarian Tissue Cryopreservation

A surgical procedure in which a portion of ovarian tissue is removed and frozen before cancer treatment. After treatment, the tissue can be transplanted back, potentially restoring both fertility and hormonal function. This option is particularly important for prepubertal girls who cannot undergo egg freezing, and for patients who cannot delay treatment for the 10–14 days required for egg stimulation. Over 200 live births have been reported from transplanted ovarian tissue worldwide.

Ovarian Suppression (GnRH Agonists)

Monthly injections of GnRH agonists (such as leuprolide/Lupron) during chemotherapy may reduce ovarian damage by temporarily shutting down ovarian function. The evidence is mixed but suggests a protective effect, particularly for younger women. This is sometimes used in addition to egg or embryo freezing, not as a replacement for it.

Preservation Options for People With Testes

Sperm Banking (Sperm Cryopreservation)

The simplest and fastest preservation option. One or more semen samples are collected, analyzed, and frozen. The entire process can be completed in a single day—making it feasible even when cancer treatment must begin immediately. Multiple samples over several days are ideal if time permits, as this maximizes the total number of vials available for future use.

Cost: $500 to $1,000 for initial banking plus $200 to $500 per year for storage. Many cancer programs and sperm banks offer discounted or free banking for cancer patients. A sterile specimen collection cup may be provided by your clinic, or you may need to bring your own.

Testicular Sperm Extraction (TESE)

For patients who cannot produce a sample through ejaculation (due to the cancer itself, surgery, or other factors), sperm can be surgically extracted from testicular tissue. This is a more invasive procedure but can provide viable sperm for future IVF with ICSI.

What to Do Right Now

If you have just been diagnosed with cancer and want to preserve your fertility, take these steps today: Tell your oncologist that fertility preservation is important to you. Ask for an urgent referral to a reproductive endocrinologist or oncofertility specialist. Ask your oncologist how many days you have before treatment must begin—even 7–14 days may be enough for egg freezing. Call Livestrong Fertility (1-855-220-7777) for immediate guidance and financial assistance information. If you have testes, a sperm bank can process and freeze a sample within 24 hours.

For more on the IVF process that you’ll encounter during egg or embryo freezing, see ConceiveGuide’s week-by-week IVF timeline.