Key Facts About Fertility and Cancer
- Many cancer treatments can temporarily or permanently affect fertility, but preservation options exist for most patients
- Fertility preservation is most effective when planned before treatment begins — discuss options with your oncologist as soon as possible after diagnosis
- ASCO recommends that oncologists discuss fertility risks and preservation options with all patients of reproductive age at the time of diagnosis
- Having children after cancer treatment is possible for many survivors, including through assisted reproduction and adoption
How Cancer Treatment Affects Fertility
The impact of cancer treatment on fertility depends on the type of treatment, the drugs used and their doses, the area of the body treated with radiation, and the patient’s age and pre-existing fertility status.
Chemotherapy and Fertility
Chemotherapy drugs that pose the highest risk to fertility include alkylating agents (cyclophosphamide, ifosfamide, busulfan, melphalan) and platinum-based drugs (cisplatin). These agents damage rapidly dividing cells, including eggs in the ovaries and sperm-producing cells in the testes. The risk increases with higher cumulative doses and with combinations of gonadotoxic drugs.
- In women: Chemotherapy can damage or destroy eggs, leading to premature ovarian failure (early menopause). Younger women generally tolerate more treatment before losing ovarian function because they start with a larger egg reserve. Women over 35 face higher risk of permanent infertility from the same drug regimens.
- In men: Chemotherapy can reduce or halt sperm production. Sperm counts may recover months to years after treatment, but recovery is not guaranteed, especially with high-dose alkylating agents.
Radiation and Fertility
Radiation therapy to the pelvis, abdomen, or total body irradiation (used before bone marrow transplant) can directly damage reproductive organs. Radiation to the brain can affect the pituitary gland, which controls hormonal signals to the ovaries and testes.
Surgery and Fertility
Surgical removal of reproductive organs (oophorectomy, orchiectomy, hysterectomy) directly eliminates or reduces fertility. Even surgeries that spare reproductive organs may affect blood supply or nerve function important for fertility and sexual function.
| Treatment | Risk to Female Fertility | Risk to Male Fertility |
|---|---|---|
| Alkylating agents (high dose) | High — premature ovarian failure likely | High — prolonged or permanent azoospermia |
| Alkylating agents (low dose) | Moderate — age-dependent risk | Moderate — recovery possible |
| Platinum-based (cisplatin) | Moderate | Moderate to high |
| Antimetabolites (5-FU, methotrexate) | Low | Low — usually temporary |
| Pelvic radiation (>6 Gy to ovaries) | High — ovarian failure likely | High — testicular damage likely |
| Total body irradiation | Very high | Very high |
Fertility Preservation Options
Options for Men
Sperm banking (cryopreservation) is the most established and effective fertility preservation method for men. Sperm samples are collected through masturbation, frozen in liquid nitrogen, and stored at a sperm bank or fertility clinic. The process takes one to two days and can usually be completed before treatment begins. Multiple samples are recommended when possible. Sperm can be stored indefinitely and used later for intrauterine insemination (IUI) or in vitro fertilization (IVF).
Testicular tissue cryopreservation is an experimental option for prepubescent boys who cannot produce mature sperm. A small piece of testicular tissue is surgically removed and frozen. Researchers are working on methods to mature sperm from this tissue in the future.
Testicular shielding involves placing a lead shield over the testes during radiation therapy to the pelvis or nearby areas, reducing radiation exposure to the reproductive organs.
Options for Women
Egg freezing (oocyte cryopreservation) is now considered standard of care. It involves 10–14 days of hormonal stimulation to produce multiple eggs, followed by an egg retrieval procedure. The eggs are vitrified (flash-frozen) and stored. No partner or sperm donor is needed. Success rates depend on the number of eggs retrieved and the patient’s age at the time of freezing.
Embryo freezing follows the same stimulation and retrieval process as egg freezing, but eggs are fertilized with sperm (from a partner or donor) before freezing. Embryo freezing has a slightly higher success rate than egg freezing per embryo transferred, but requires a sperm source at the time of preservation.
Ovarian tissue cryopreservation involves surgically removing and freezing a portion of ovarian tissue before treatment. After cancer treatment is complete, the tissue is transplanted back, potentially restoring both fertility and hormonal function. This is the only option for prepubescent girls and can be performed without delaying treatment.
GnRH agonist suppression (such as leuprolide or goserelin) is a monthly injection given during chemotherapy to temporarily shut down ovarian function, with the goal of protecting eggs from chemotherapy damage. Evidence for this approach is growing, particularly for breast cancer patients, but it is considered supplementary and should not replace established preservation methods.
Timing Before Treatment
Timing is one of the most critical factors in fertility preservation. For men, sperm banking can often be completed within one to two days. For women, egg or embryo freezing typically requires 10–14 days for ovarian stimulation, though new “random start” protocols allow stimulation to begin at any point in the menstrual cycle, reducing wait times.
Discuss fertility preservation with your oncologist at your very first appointment. Many cancer centers have established partnerships with fertility clinics and can arrange rapid referrals. Your oncologist can advise whether a brief delay in treatment (typically two weeks or less) is safe for fertility preservation.
Costs and Financial Assistance
| Procedure | Approximate Cost (US) | Annual Storage |
|---|---|---|
| Sperm banking | $500–$1,500 | $200–$500/year |
| Egg freezing (including medications) | $8,000–$15,000 | $500–$800/year |
| Embryo freezing (including medications) | $10,000–$17,000 | $500–$800/year |
| Ovarian tissue cryopreservation | $10,000–$20,000 | $500–$1,000/year |
| GnRH agonist (per injection) | $500–$1,500 | N/A |
Insurance coverage varies widely. Some states have mandated fertility preservation coverage for cancer patients (including Connecticut, Illinois, New York, and others). Financial assistance programs include:
- Livestrong Fertility: Reduced-cost fertility preservation for cancer patients through a network of partner clinics
- Heart Beat Program: Free fertility preservation services for qualifying cancer patients
- Alliance for Fertility Preservation: Information and resources for finding financial support
- Pharmaceutical patient assistance programs: Some medication manufacturers offer free or reduced-cost fertility drugs to cancer patients
See our financial assistance guide for additional resources and programs.
Pregnancy After Cancer
Many cancer survivors go on to have healthy pregnancies and children. Key considerations include:
- Timing: Most oncologists recommend waiting at least one to two years after completing treatment before attempting pregnancy, as recurrence risk is highest in this period. Discuss your specific timeline with your oncology and fertility teams.
- Hormonal considerations: Women with hormone-receptor-positive cancers (such as some breast cancers) may need to pause hormonal therapy temporarily for pregnancy. The POSITIVE trial demonstrated that this interruption does not increase recurrence risk for most patients.
- Monitoring: Pregnancies after cancer are not inherently high-risk, but your obstetric team should be aware of your cancer history and any treatments that may affect pregnancy (such as prior pelvic radiation or anthracycline chemotherapy).
- Cancer in offspring: With few exceptions (such as certain inherited genetic mutations), cancer treatments do not increase the risk of cancer or birth defects in children conceived after treatment ends.
Adoption After Cancer
Adoption is a viable path to parenthood for cancer survivors. While some survivors worry about discrimination during the adoption process, cancer history alone should not prevent adoption. Be prepared to provide a letter from your oncologist documenting your current health status, prognosis, and fitness to parent. Both domestic and international adoption agencies have approved cancer survivors. Your oncology social worker can help navigate the process and connect you with adoption agencies experienced in working with cancer survivors.
Do Not Delay This Conversation
If you have been diagnosed with cancer and are of reproductive age or have not completed your family, bring up fertility preservation at your very first oncology appointment. Once cancer treatment begins, options become more limited. Even if you are unsure about wanting children in the future, preserving the option now gives you the choice later.
Related Resources
- Chemotherapy — Treatment details and how drugs affect the body
- Radiation Therapy — Understanding radiation’s impact on fertility
- Cancer Survivorship — Long-term health and wellness after treatment
- Financial Assistance — Help with fertility preservation costs
- Emotional Health — Coping with fertility-related grief and decision-making
- Find a Doctor — Locate a reproductive endocrinologist or fertility clinic
Last reviewed: March 2026. Fertility preservation options and success rates continue to improve. Always consult both your oncologist and a reproductive endocrinologist for personalized guidance based on your specific cancer, treatment plan, and reproductive goals.