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Preserving Fertility after a Cancer Diagnosis

A new cancer diagnosis can be overwhelming, with many decisions needing to be made quickly. Because the immediate focus is usually on starting treatment, fertility preservation is often not discussed early in the process. But for patients in their reproductive years who may want to have children in the future, fertility is an important consideration.  

Fertility preservation is time-sensitive, and having early conversations can significantly impact a patient’s future options. Fertility concerns go beyond the ability to become pregnant and can also include ovarian function, early menopause, sexual health, endocrine effects, and the ability to carry a pregnancy safely after treatment. 

In this article, Private Health Management (PHM) experts emphasize the importance of pausing early in the diagnostic process to consider fertility. We highlight gaps in awareness, timing, and coordination; review how cancer treatment affects fertility; summarize preservation options; and outline key questions patients should ask at diagnosis, before treatment, during survivorship, and when they are ready to pursue pregnancy. 

Fertility preservation during cancer treatment is increasingly important 

Each year in the United States, about 90,000 adolescents and young adults aged 15–39 are diagnosed with cancer.1 A diagnosis at this stage of life can disrupt education, careers, relationships, and future family planning. Cancer outcomes have also improved, meaning more people are living long, full lives after their treatment.2 As a result, care has expanded beyond basic survival to include long-term quality of life, including fertility.  

Current medical guidelines recommend discussing fertility preservation at diagnosis and during survivorship.3 This reflects how common fertility concerns are among patients, including: 

  • Many young patients worry about whether they will be able to have children in the future, with studies showing that approximately 44% to 86% report concerns about their fertility.4  
  • In young women with breast cancer, about one third want children and half are concerned about infertility.5  
  • Fertility challenges are increasingly common in the general population, meaning some patients may enter cancer treatment with underlying or unrecognized concerns. 

Despite these factors, fertility preservation is not consistently addressed: 

  • Only about 44% of young patients report receiving fertility counseling before chemotherapy. 
  • Only about 20–25% are referred to a specialist.6  

Taking some time at the point of diagnosis to have even a brief conversation about fertility can help patients understand their options and plan for the future. This discussion should address whether fertility may be affected, as well as how high the risk is based on the specific treatment plan, the patient’s age, and baseline reproductive health. 

Why timing and coordination matter 

Timing and coordination are two of the biggest challenges in fertility care. Both cancer treatment and fertility preservation are time-sensitive, making early awareness and quick action critical to preserving reproductive options.3 For women, this process often requires several steps that take time to complete, including connecting with a fertility specialist, hormonal stimulation, and egg retrieval. These steps rely on timely referral and effective coordination between oncology and fertility specialists, which does not always happen in routine clinical practice.  

In some instances, pursuing fertility preservation may delay the start of cancer treatment. In other cases, cancer treatment cannot be safely delayed, which may limit or eliminate certain options. Early referral can expand the range of preservation strategies available, rather than simply delaying cancer treatment. 

Cost and access can add another layer of complexity. Fertility preservation services are not always covered by insurance, and out-of-pocket costs may be significant, particularly for younger patients. Navigating these medical, logistical, and financial challenges makes early action essential. Without timely referral and coordination, women may completely miss the window to pursue fertility preservation.  

How cancer treatment can affect a woman’s fertility and what can be done 

Women are born with a finite number of eggs, and damage to this supply (the ovarian reserve) may be permanent. Fertility risk varies based on the individual’s type and dose of cancer therapy, their age, and their baseline ovarian reserve before starting treatment. 

Cancer treatments can impair fertility in different ways:  

  • Chemotherapy: These medications may damage the ovaries and reduce the number and quality of a woman’s remaining eggs. 
  • Radiation: Radiation therapy directed at or near the pelvis can negatively affect both the ovaries and the uterus.  
  • Surgery: Certain surgical procedures may remove or impact reproductive organs.  

Several fertility preservation options are available and are typically considered before treatment begins (Table 1). These approaches differ in timing, complexity, and likelihood of success. Not all patients are candidates for every method and what is possible depends on how quickly treatment must start and the patient’s overall clinical situation. Some patients may not be able to safely delay treatment long enough to pursue certain strategies.  

Table 1. Established fertility preservation options for women3,7,8 

Strategy What it involves Timing Key considerations 
Egg freezing (oocyte cryopreservation) Hormonal stimulation to mature eggs, followed by egg retrieval and freezing Usually takes ~2–3 weeks Timing depends on where a patient is in their menstrual cycle Commonly used May not be feasible if cancer treatment must start immediately 
Embryo freezing  Eggs are retrieved, fertilized with sperm, and frozen as embryos Similar to egg freezing (~2–3 weeks), with timing dependent on menstrual cycle May be started quickly in some cases but can still delay treatment Well-established success rates Requires sperm (partner or donor) Same timing constraints as egg freezing 
Ovarian tissue cryopreservation Surgical removal and freezing of ovarian tissue for later use Can often be done quickly, sometimes within days, without waiting for a menstrual cycle May be an option when treatment is urgent Increasingly used but less established than egg/embryo freezing 
Ovarian suppression (medications) Medications (e.g., GnRH agonists) given during treatment to temporarily suppress ovarian function Started before or with chemotherapy Does not delay treatment May offer some protection Evidence is mixed Typically used in addition to other methods, not alone 

Fertility preservation may also be considered for younger patients, including children and adolescents who have not yet gone through puberty. In these cases, options are often more limited and may involve tissue preservation rather than standard egg or sperm freezing. These decisions are typically made quickly with parents or caregivers before treatment begins. 

Given these complex medical variables, early consultation with a fertility specialist is crucial. They can quickly assess the patient’s specific clinical situation and clarify exactly which preservation options are medically appropriate and realistic before cancer treatment begins. 

What’s changing: newer and emerging fertility preservation approaches 

Research in the field of fertility preservation is still evolving. Emerging technologies aim to expand on current strategies and develop novel approaches, especially when standard ones are not viable.7,8  

Some techniques, such as artificial ovaries and in vitro follicle maturation aim to mature eggs outside of the body, in a lab setting. These may be particularly useful for patients who cannot delay treatment for hormonal stimulation or need to avoid hormone exposure.  

Another technique is pharmacologic protection, which involves medications given during treatment to preserve ovarian function. This may provide another option as it does not cause any delay in the start of cancer treatment and may be used in combination with other strategies.  

These technologies are at different stages of development; artificial ovaries are in early, preclinical stages, while in vitro follicle maturation and pharmacologic protection are available in clinical settings while continuing to be improved. Even with these exciting developments, established methods for fertility preservation remain the standard. 

Considerations for men with a cancer diagnosis  

For men facing a cancer diagnosis, recovery of fertility after treatment is sometimes possible, but it is not guaranteed. Sperm banking is a simple and effective way to preserve fertility before treatment. It can usually be completed quickly and does not delay cancer treatment. Despite this, many men are not counseled about fertility preservation before treatment begins. In situations where a sperm sample cannot be provided, additional options such as surgical sperm retrieval may be considered.  

What patients can do: start the conversation early 

  • Ask about the risks: At the time of diagnosis or soon after, ask your oncologist whether the cancer treatment strategy may affect your fertility.  
  • Check your timeline: Ask if there is time to consider fertility preservation before starting treatment.  
  • Get connected: Request a referral to a fertility specialist as soon as possible.  
  • Share your priorities: Discuss personal goals and priorities related to future family planning with the care team.  

How PHM can help 

PHM’s Personal Care Teams support clients facing a cancer diagnosis by helping ensure fertility is considered early in care. We provide ongoing guidance as clients navigate these complex, time-sensitive decisions. This includes facilitating rapid referrals to a trusted network of fertility specialists and supporting direct communication between oncology and reproductive teams to reduce delays and streamline care. 

To learn more, visit privatehealth.com. 

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Farrah Farquharson

Farrah Farquharson, PA-C

Associate Clinical Director | Physician Assistant

Lily Hurtado

Lilly Hurtado, PhD

Research Director, Oncology

Julie Nowicki

Julie Nowicki, PhD

Science Communications Specialist

Julie is a Science Communications Specialist at Private Health Management, where she collaborates with the Research and Clinical teams to translate complex scientific concepts into clear, accessible information for clients and their families. Her work helps bridge the gap between cutting-edge research and personalized patient care. A scientific and medical writer by training, Julie has developed content for both clinical and patient audiences across a range of therapeutic areas, including oncology, hematology, dermatology, and women’s health. Before joining PHM, she served as a Senior Medical Writer, where she created clinical manuscripts, abstracts, congress materials, and educational resources for pharmaceutical clients. Julie earned her PhD in Cell, Molecular, and Developmental Biology from the University of North Carolina at Chapel Hill.