Fertility preservation before cancer treatment
A cancer diagnosis at a young age brings many urgent questions. One of them, often not discussed in time, is fertility: several cancer treatments — chemotherapy, radiation, certain operations — can permanently damage the ability to have children.
The good news is that today there are effective methods of preserving fertility. The critical element is time: the discussion and referral must happen urgently, ideally before cancer treatment begins.
Why does cancer treatment affect fertility?
Many chemotherapy drugs, especially the so-called alkylating agents, are toxic to the ovaries and testes. They can reduce or deplete the reserve of eggs or disrupt sperm production. Radiation to the pelvic area or to the brain (which regulates hormones) has similar effects.
The degree of damage depends on the type and dose of treatment and on age. Because it is hard to predict precisely who will be affected, fertility preservation should be discussed with every patient of reproductive age.
Why does timing matter so much?
Some methods, such as egg or embryo freezing, require a period of ovarian stimulation of about two to three weeks. For this reason referral to a reproductive specialist must happen urgently, as soon as the diagnosis is made and before gonadotoxic treatment begins.
Modern “random start” techniques allow stimulation to begin at any phase of the cycle, so that no valuable time is lost. Even so, good cooperation between the oncologist and the fertility specialist is essential.
What are the options for women?
The most established method is freezing mature eggs or embryos (after ovarian stimulation and retrieval). Embryo freezing requires sperm from a partner or donor, while egg freezing gives the woman greater autonomy.
A third option is ovarian tissue freezing, which needs no stimulation or delay and is the only possibility for prepubertal girls. Depending on the type of cancer, surgical repositioning of the ovaries out of the radiation field may also be considered.
What are the options for men?
For men, fertility preservation is simpler and very fast: sperm freezing before treatment begins. It is an effective, non-invasive method that does not delay cancer treatment.
In adolescents or men who cannot provide a sample, or in some forms of azoospermia, surgical sperm retrieval from the testis may be considered. For prepubertal boys, freezing testicular tissue is still experimental.
What are GnRH agonists during chemotherapy?
GnRH agonists are injectable drugs that temporarily “put the ovaries to sleep” during chemotherapy, aiming to partially protect them. They may be offered, particularly to women with breast cancer, as an adjunctive measure.
It is important to stress, however, that they do not replace the established methods: they should not be used instead of egg, embryo or ovarian-tissue freezing, but only as an additional, not guaranteed, safeguard.
Is fertility preservation safe for a cancer patient?
In the great majority of cases, yes. Ovarian stimulation can be adapted to be safe even in hormone-dependent cancers, such as breast cancer, using specific protocols. The procedure is always planned in close cooperation with the oncologist.
The decision is individualized on the basis of the type and stage of cancer, the time available and the patient’s wishes. The goal is twofold: not to delay cancer treatment and, at the same time, to protect where possible the possibility of future childbearing.
Summary
Many cancer treatments can permanently damage fertility, so referral to a reproductive specialist must happen urgently, before they begin. For women, the main options are egg or embryo freezing and ovarian tissue freezing; GnRH agonists are offered as an adjunctive, not an alternative, measure. For men, sperm freezing is simple and effective. With proper planning and cooperation between oncologist and fertility specialist, fertility preservation is safe and does not delay cancer treatment.
Sources: ESHRE, “Female fertility preservation” (guideline); ASRM Practice Committee, “Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy” (Committee opinion).
⚕ Medically reviewed by Prof. Stratis Kolibianakis · Thessaloniki Medical Association Reg. No. 16340
ARTICLE 28 · FERTILITY PRESERVATION
