17000 Fertility Preservation

Overview

Fertility preservation means taking steps to protect your ability to have a baby in the future. It is offered when something in your life or health could harm your fertility — your natural ability to get pregnant or to father a child. The most common reason is medical treatment, such as chemotherapy (strong medicine that kills cancer cells) or radiotherapy (radiation treatment), which can damage the eggs in the ovaries or the sperm-making cells in the testicles. Fertility preservation can also be a personal choice, for example if you want to delay having children until later in life. Options include freezing eggs, sperm or embryos (a fertilised egg), and sometimes surgery or medicines to protect the reproductive organs before other treatment starts.

Fertility problems in general are common, and being offered a conversation about fertility preservation is increasingly routine. Cancer teams and other specialists now raise the topic early, because there are often ways to help. Even so, many people only learn about their options when they are already facing a serious diagnosis, so it is worth asking about it yourself if no one has mentioned it.

Fertility preservation can be relevant for anyone of reproductive age. This includes people who are about to have cancer treatment, people facing surgery that removes the ovaries, testicles or womb, people with conditions such as endometriosis (a condition where tissue like the womb lining grows elsewhere) or serious autoimmune conditions, people with genetic conditions that cause early menopause, transgender and non-binary people before hormone treatment or surgery, and anyone who simply wants the option of children later. It applies to people of all genders, including children and teenagers who are about to have treatment that could affect their future fertility.

Symptoms

Common symptoms

• There are usually no physical symptoms that tell you to think about fertility preservation. Instead, the prompt is a diagnosis or a planned treatment.
• You may be told that a treatment you need — such as chemotherapy, radiotherapy to the pelvis or brain, or surgery on the reproductive organs — could affect your fertility.
• You may notice changes in your periods, such as them becoming irregular or stopping, during or after treatment.
• You may find yourself thinking about children more often, or worrying about whether you will be able to have them.
• Some people notice a change in sexual function or interest, which can be linked to treatment, stress or hormone changes.

Symptoms in children

• In children and teenagers, the topic usually comes up because cancer treatment or other medical treatment is planned.
• Children will not usually have symptoms of their own — parents and carers are the ones who discuss options with the medical team.
• Puberty may start earlier, later or differently after some treatments, and this is monitored by the specialist team.
• For young children, options may be limited to storing tissue, which is only available at some specialist centres and is often done as part of a research programme.

Symptoms in older adults

• Natural fertility usually ends with the menopause, so egg freezing is generally not an option afterwards.
• Some people still need advice about preserving fertility before surgery or treatment, even close to the menopause.
• Older adults may be supporting a partner, son or daughter through the decision, and can be part of those conversations.
• For people who have already stored eggs, sperm or embryos, storage has time limits and paperwork that must be kept up to date.

Causes

Main causes

• Cancer treatment — chemotherapy, radiotherapy, or both — can damage eggs or sperm-making cells.
• Surgery that removes the ovaries, testicles or womb, or surgery that affects the blood supply to these organs.
• Some medicines used for other health conditions, such as long-term treatment for autoimmune diseases.
• Genetic conditions that cause early menopause, or a family history of early menopause.
• Conditions such as endometriosis, or repeated ovarian surgery, which can reduce the number of eggs available.
• Gender-affirming hormone treatment and surgery, which can affect fertility.
• Personal choice — wanting to keep the option of children open while focusing on study, work, health or finding a partner.

Risk factors

• Increasing age — egg quality and numbers fall naturally over time, especially after the mid-thirties.
• The type, dose and length of treatment you need, and which part of the body is treated.
• Radiotherapy aimed at the pelvis, lower abdomen, or the area around the brain that controls hormones.
• Already having an existing fertility problem, or a low number of eggs (sometimes called low ovarian reserve).
• Smoking, heavy alcohol use and being very underweight or overweight, which can affect fertility.
• A need to start treatment very quickly, which can limit the time available for fertility preservation.

When to see a doctor

See a doctor urgently if:

• You are about to start treatment that could affect your fertility and no one has talked to you about preserving it — ask your specialist team for an urgent referral to a fertility service.
• You have sudden, severe pain in the testicles or lower abdomen.
• You have heavy vaginal bleeding with dizziness or fainting.
• You have a high temperature or feel very unwell during or shortly after treatment.
• You feel unable to cope or have thoughts of ending your life — get help the same day.

Book a routine appointment if:

• You are thinking about having children later and want to understand your options.
• You have a family history of early menopause or a known genetic condition affecting fertility.
• You have irregular or absent periods and are planning a pregnancy.
• You are due to start gender-affirming treatment and want to discuss fertility.
• You have stored eggs, sperm or embryos and are unsure about your storage renewal or how to use them.

Diagnosis

Fertility preservation is not a diagnosis in itself — it is a set of choices. What you will have is an assessment, usually with a fertility specialist, to see which options could work for you and how quickly they could be done. This involves talking about your health, your treatment plan, your age and your wishes, plus a few quick tests. The specialist will also explain the realistic chance of success for each option, including the chance that it may not work.

Tests that may be done

• A conversation about your medical history, your treatment timeline and your plans for children.
• Blood tests to check hormone levels and give an idea of how many eggs you have (sometimes called ovarian reserve testing).
• A vaginal ultrasound scan to count the small follicles (fluid-filled sacs that hold eggs) in the ovaries.
• A semen analysis, if sperm freezing is being considered.
• Screening tests for infections, which are routine before any fertility procedure.
• For children, imaging and discussion with a specialist paediatric fertility team.

What to expect at your appointment

You may be seen very quickly — sometimes within 24 to 48 hours — if your other treatment is urgent. The first appointment is mostly a conversation, followed by tests that can often be done the same day. Egg freezing involves a short course of hormone injections, several scans, and a small procedure to collect the eggs, so it takes roughly two to three weeks from start to finish. Sperm freezing can usually be arranged within days. Your team will explain what is possible in the time you have.

Treatment

Fertility preservation is about storing or protecting what you have, so that you have choices later. The main options are freezing eggs, freezing sperm, freezing embryos (an egg that has been fertilised with sperm), and storing ovarian or testicular tissue, which is only offered at some specialist centres. Sometimes the aim is to protect the organs during treatment instead — for example, by shielding them during radiotherapy or by moving the ovaries out of the radiation field. Your team will help you weigh up which option suits your age, health, treatment plan, values and the amount of time you have.

Self-care at home

• If you smoke, stopping is one of the most helpful things you can do for your fertility, for you and any partner.
• Eat a balanced diet and keep active — you do not need a special diet, just regular, varied meals.
• Limit alcohol, and avoid recreational drugs.
• Try to keep to a healthy weight; being very underweight or very overweight can affect fertility.
• Aim for regular sleep and gentle movement; stress does not stop you getting pregnant, but it does affect how you feel.
• Write down your questions before appointments and take someone with you if you can — it is hard to remember everything.
• Ask your clinic for written information and a contact for follow-up questions; there is no such thing as a silly question here.

Medical treatments

Fertility preservation options fall into a few broad groups. Egg freezing involves a short course of hormone injections to encourage several eggs to mature, followed by a small procedure to collect them under sedation or light anaesthetic. Embryo freezing uses the same process, then fertilises the eggs with sperm from a partner or a donor before freezing. Sperm freezing is simple, usually just one or two samples produced at the clinic. Ovarian tissue freezing means removing a small piece of ovary by keyhole surgery and storing it, with the aim of putting it back later; this is done in specialist centres and is often offered within a research programme. Testicular tissue freezing for children is still experimental and only available in some centres. Separately, your cancer team may use treatments or techniques designed to shield the reproductive organs during radiotherapy, or use medicines intended to rest the ovaries during chemotherapy. Your specialist will explain the realistic chances of success for each option, the risks, and the costs, which vary between services and countries.

When is surgery considered?

Surgery plays a part in a few situations: keyhole surgery to collect a piece of ovarian tissue for storage; surgery to move the ovaries higher in the abdomen so they are out of the radiotherapy field; and procedures to collect sperm directly from the testicle when a sample cannot be produced in the usual way. All of these are planned in advance with your team and timed around your other treatment.

Living with this condition

After preservation, life usually carries on much as before. You may have follow-up appointments to check how you are doing, and you will need to keep your storage paperwork and payments up to date if there are fees. If you stored eggs or embryos, you may later need a fertility clinic appointment when you decide to try for a pregnancy. Some people find they think about their stored samples often at first and then hardly at all — both are normal.

Lifestyle tips

• Keep a simple record of where your samples are stored, who to contact, and any renewal dates.
• Tell your GP or family doctor that you have stored eggs, sperm or embryos — it is useful background for future care.
• If you are having treatment that affects hormones, ask what to expect for your periods, mood, bone health and sexual wellbeing.
• Keep up routine health checks and cervical screening as advised; ask your team when to book them.
• Build a small support network — a friend, partner, family member or counsellor you can talk to openly.

Diet and exercise

There is no special diet that protects or improves stored eggs or sperm. A balanced, varied diet and regular movement you enjoy are the main things — aim for something like 150 minutes a week of moderate activity such as walking, swimming or cycling, adapted to how you feel. If you are having hormone treatment, gentle strength work helps look after your bones. Ask your team before starting anything strenuous, especially during or just after treatment.

Mental health and emotional wellbeing

Being told that your fertility might be affected can bring up grief, fear, anger or a sense of lost control — often at the same time as coping with a serious illness. Decisions can feel rushed, and some people worry they made the wrong choice. These feelings are common and understandable. Talking helps: a counsellor attached to your fertility or cancer team, a trusted friend, or a support group can all make a difference. If you ever feel overwhelmed, hopeless, or have thoughts of harming yourself, please reach out for help straight away — contact your local emergency services, your doctor, or a crisis helpline in your country. You do not have to manage this alone.

Prevention

You cannot prevent the need for fertility preservation — it is a choice you make in response to a health situation or a life plan. What you can do is protect your general fertility: avoid smoking, limit alcohol, keep to a healthy weight, and treat infections promptly. The most important step is not to delay the conversation. If you are told you need treatment that could affect your fertility, ask about preservation before treatment starts, even if it feels awkward or the appointment is busy.

Screening programmes

There is no general screening programme for fertility. Some people have tests to check egg numbers or sperm quality if they have a family history of early menopause, a known genetic condition, or a health problem that can affect fertility. If you are planning a pregnancy or worried about your fertility, your GP can arrange an initial assessment.

Complications

If left untreated

• Some treatments can cause permanent infertility, meaning you would not be able to conceive naturally.
• Treatment can bring on early menopause, with symptoms such as hot flushes, mood changes and effects on bone and heart health.
• You may later need donor eggs or sperm, or surrogacy, which can add emotional, practical and financial strain.
• Being unable to have children when you wanted to can cause lasting grief and distress.
• Some people feel regret or anger about not being told about options at the time.

Long-term outlook

The outlook is genuinely hopeful. Fertility preservation has improved a lot, and many people who store eggs, sperm or embryos go on to have children, either naturally or with help. Even when preservation is not possible, there are often other routes to parenthood, including donor eggs or sperm, surrogacy arrangements where legal, and adoption. Not everyone needs to use what they stored — and knowing the option is there can bring real peace of mind while you focus on getting well.

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