Fertility is a common concern for people who have been newly diagnosed with cancer, and many wonder whether they will be able have children after their treatment.
The answer isn’t always clear. Unfortunately, some cancer treatments can make it more difficult, sometimes even impossible, to create a pregnancy. Infertility may be temporary or permanent.
For example, the strong cancer-fighting drugs used in chemotherapy may also damage egg and sperm cells and the organs that create them (ovaries and testes). Strong x-rays used in radiation therapy can also cause damage.
Surgery can also make patients infertile. If the ovaries or testes need to be removed, then it will be impossible for the body to make eggs or sperm cells. If the uterus is removed, then a pregnancy is not possible. If nerves are damaged during surgery, men may not be able to ejaculate sperm.
While this news can be heartbreaking, there is hope. Fertility preservation encompasses many ways that cancer survivors may still have children after treatment. These approaches may include:
- Cryopreservation. Reproductive cells or tissue are “harvested” before treatment begins and kept frozen until a pregnancy is desired.
- Radiation shielding. Cells and tissues may be protected from the strong x-rays used during radiation therapy.
- Surgery. The ovaries may be surgically repositioned to make them less vulnerable to damage. If one ovary needs to be removed, it may be possible to keep the other one intact.
- Hormonal therapy. Hormonal therapy may allow women with endometrial cancer to have children before they have cancer-treating surgery.
Sometimes, more than one method is used.
Some cancer treatments can make it more difficult, sometimes impossible, to create a pregnancy.
Fertility preservation takes planning. If you’re facing cancer treatment and would like to have a child in the future, it’s important to talk to your cancer care team about fertility as early as possible, before treatment begins. In some cases, fertility preservation means delaying cancer treatment, and this isn’t possible for everyone. Your doctor may also recommend that you delay pregnancy for a certain period of time after treatment.
Now, let’s look at fertility preservation approaches in more detail.
Note: In this article, we are using the terms women, men, female, and male to refer to biological sex at birth. We recognize that transgender and nonbinary individuals may have reproductive organs that do not match their gender identity.
Cryopreservation
The word cryopreservation refers to the freezing of cells or tissue for later use.
Egg banking and sperm banking
Some cancer patients decide to bank, or preserve, mature sex cells — egg cells (produced by the ovaries) or sperm cells (produced by the testes). These methods are called egg banking and sperm banking, respectively.
Cells are frozen and safely stored, sometimes for many years. (In fact, sperm cells can be frozen for decades.) When you’re ready for pregnancy, the cells are thawed and used with assisted reproductive technology (ART) methods, such as in vitro fertilization (IVF).
Egg and sperm banking may also be options for children with cancer, if they have gone through puberty.
Your doctor can give you more information about cryopreservation storage in your local area.
Cryopreservation can be costly. Check with your health insurance company to see if you have coverage. There are also annual storage fees for frozen cells and tissue.
Retrieving egg cells for egg banking
Harvesting egg cells for freezing can take a few weeks, and there are several steps:
- Hormone injections are given for 10-12 days to help the ovaries produce multiple eggs.
- Doctors typically do ultrasounds and blood work to make sure the eggs are maturing as they should.
- Once mature, a doctor uses a needle to surgically remove the eggs from the ovaries. The eggs are then retrieved through the vagina. This procedure takes about 30 minutes, and patients are given anesthesia.
Retrieving sperm cells for sperm banking
Sperm cells can be obtained in a number of ways:
- Masturbation. The man masturbates in a private room at a clinic. Sometimes, this might be done at home.
- Penile vibratory stimulation. A vibrator is applied to the tip of the penis to stimulate ejaculation.
- Electroejaculation. If you are unable to ejaculate, a device is used to stimulate the prostate gland with electrical currents, leading to ejaculation.
- Collection from urine. Some men have retrograde ejaculation, which means sperm travels backward into the bladder instead of forward out of the penis during ejaculation. In such a case, it might be possible to retrieve sperm cells from a man’s urine.
- Sperm extraction. Sperm is removed from testicular tissue with a procedure called microsurgical testicular sperm extraction (microTESE). Small incisions are made in the scrotum and testis while a man is under anesthesia. A small amount of testicular tissue is removed. It is then analyzed by a lab to see whether it contains viable sperm. If it does, the cells are harvested and frozen.
Freezing embryos
An embryo is formed when a sperm cell fertilizes an egg cell. Some cancer patients choose to have embryos created in a lab before treatment. The embryos are then frozen for the future. Egg cells and sperm cells are obtained with the same procedures described earlier in this article. When it is time for a pregnancy, embryos are thawed and implanted into the uterus.
Tissue freezing
Freezing tissue from the ovaries or testes may be another viable way to preserve fertility, especially in cancer patients who have not yet reached puberty.
Ovarian tissue
A doctor can remove tissue that contains immature eggs; however, in some cases, an entire ovary is removed. The tissue is cut into small pieces, and it can be frozen for many years.
When a person is ready for pregnancy, the tissue is thawed and surgically placed back in the abdomen, close to remaining ovarian tissue.
Freezing ovarian tissue comes with risks. In some cases, there can be undetected cancer cells in the ovarian tissue. It’s possible that these cancer cells could be returned to the body when the tissue is implanted. Your doctor will discuss the risks with you and help you make a decision based on the type of cancer you have.
Testicular tissue
Researchers are still studying whether testicular tissue can be frozen and used later to create a pregnancy. At the moment, cryopreservation of testicular tissue is considered an experimental procedure.
Radiation shielding
During external beam radiation treatment, powerful beams of energy are aimed directly at the areas affected by cancer. The beams come from a machine outside the body.
If radiation could affect your reproductive organs, your doctor may suggest radiation shielding. This means covering those organs with lead shields, worn outside the body, to keep the radiation from getting through.
Shielding may also protect from scatter radiation, when energy beams bounce off something else in the body, like another organ or piece of tissue. Scatter radiation can send energy beams in directions that aren’t intended, which can put tissue, including reproductive tissue, at risk for damage.
Surgical techniques
Ovarian transposition (oophoropexy)
Ovarian transposition is a surgical way to protect the ovaries from radiation. It involves moving the ovaries out of the way of the energy beams. Usually, they are moved to an area above where they normally sit.
For some women, the ovaries naturally fall back to their original place over time. Other women have another surgery when they are finished with their cancer treatment to move the ovaries back into place.
Ovarian transposition can be an option for females before and after puberty. The ovaries may still be at risk of scatter radiation exposure.
Other surgical approaches
Ovarian cancer
If possible, patients with early ovarian cancer may have just the affected ovary removed, with the healthy ovary staying where it is. Eggs can still be produced by the remaining ovary, and a pregnancy may still be possible.
Cervical cancer
Patients with early cervical cancer may have a procedure called radical trachelectomy. The surgeon removes the cervix, the organ that connects the uterus and the vagina. The upper portion of the vagina is also removed, but most of the uterus remains. The uterus is stitched closed in the area the cervix once was.
After this surgery, women may be able carry a fetus and deliver a baby by cesarean section.
Hormonal options
Endometrial cancer
Endometrial cancer (sometimes called uterine cancer) starts in the endometrium — the lining of the uterus. Patients with this type of cancer usually have a hysterectomy (surgery to remove the uterus), but some are able to postpone surgery until after they’ve had a child.
Doctors prescribe hormones called progestins to help cancerous tumors shrink or go away temporarily, giving patients time to have a child. However, this approach can be risky, as the cancer may still spread. Close monitoring by a doctor is critical.
After the child is born, patients have a hysterectomy.
Ovarian suppression
Pre-menopausal women might opt for ovarian suppression, which uses medicines called GnRH agonists to stop the ovaries from making the hormone estrogen. Some experts believe that this process protects egg cells from cancer treatment. This approach is still being studied, and the Alliance for Fertility Preservation considers it experimental.
Is fertility preservation always successful?
While fertility preservation techniques offer hope to cancer patients looking to start or expand their family, they cannot guarantee a pregnancy.
Age can be a significant factor. For example, women who are younger when their eggs are retrieved tend to have a better chance of pregnancy than women who are older.
Also, the type and stage of your cancer may play a role. Your doctor can give you more details about your personal situation.
Keep in mind that even if fertility preservation efforts are not successful, you can still grow your family:
- If a woman’s eggs or man’s sperm cells are not viable, a couple might consider using egg or sperm cells from a donor. With this approach, a sperm cell fertilizes an egg cell in a lab to create an embryo. The embryo is then implanted into the uterus and the baby is carried to term.
- If a person is unable to carry a pregnancy (for example, if their uterus has been removed), they might consider using a gestational carrier (sometimes called a gestational surrogate). A gestational carrier has the embryo placed in their uterus and carries the baby until birth.
Questions to ask your cancer care team
You’ll likely be meeting with several specialists throughout your cancer journey. Chances are, you’ll have lots and lots of questions, and that’s normal. Sometimes, it’s hard to keep all our questions straight, especially when we’re talking to healthcare providers. This list can help. Be sure to jot down any additional questions you have.
- Will you refer me to a fertility preservation specialist?
- What fertility preservation options do I have? What do they entail?
- What are the risks and benefits of my options?
- How successful are these approaches for someone in my situation?
- When would fertility preservation efforts start?
- Will I need to delay my cancer treatment? If so, is that okay?
- Will I need to have surgery? What are the details of the procedure? What kind of a recovery might I expect?
- Can you recommend a reliable sperm bank or egg bank?
- How long can my cells or tissue be frozen?
- How much do these approaches cost?
- Can cancer cells be reintroduced to my body through any of the procedures above?
- How soon after treatment can I try for a pregnancy?
- Will I need to use assisted reproductive technology (ART)?
- Can you refer me to a support group or a counselor?
Resources
Alliance for Fertility Preservation
“Ovarian Transposition”
(no date)
https://www.allianceforfertilitypreservation.org/options-for-Patients/ovarian-transposition/
“Ovarian Suppression”
(no date)
https://www.allianceforfertilitypreservation.org/options-for-Patients/ovarian-suppression/
American Cancer Society
Susan G. Komen
“Ovarian Suppression”
(Updated: March 3, 2025)
https://www.cancer.org/cancer/managing-cancer/side-effects/fertility/preserving-fertility-in-Patients.html
“Preserving Your Fertility When You Have Cancer (Men)”
(Last Revised: January 17, 2025)
https://www.cancer.org/cancer/managing-cancer/side-effects/fertility/preserving-fertility-in-men.html
“Preserving Your Fertility When You Have Cancer (Patients)”
(Last Revised: January 17, 2025)
https://www.cancer.org/cancer/managing-cancer/side-effects/fertility/preserving-fertility-in-Patients.html
“Radiation Therapy”
(Last Revised: June 9, 2025)
https://www.cancer.org/cancer/managing-cancer/treatment-types/radiation.html
“Surgery for Cervical Cancer”
(Last Revised: June 28, 2024)
https://www.cancer.org/cancer/types/cervical-cancer/treating/surgery.html
“Treatment Choices for Endometrial Cancer, by Stage”
(Last Revised: February 28, 2025)
https://www.cancer.org/cancer/types/endometrial-cancer/treating/by-stage.html
American Urological Association
“Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline”
(2024)
https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility#x15007
Cleveland Clinic
“Electroejaculation”
(Last reviewed: August 12, 2022)
https://my.clevelandclinic.org/health/treatments/23997-electroejaculation
“Microsurgical Testicular Sperm Extraction (microTESE)”
(Last reviewed: March 26, 2024)
https://my.clevelandclinic.org/health/procedures/microtese
Johns Hopkins Medicine
Hosseinzadeh, Pardis, MD, MSC
“Freezing Eggs: Preserving Fertility for the Future”
(February 24, 2025)
https://www.hopkinsmedicine.org/health/wellness-and-prevention/freezing-eggs-preserving-fertility-for-the-future
“Ovarian Tissue Freezing (Cryopreservation)”
(no date)
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ovarian-tissue-freezing-cryopreservation
Journal of Clinical Oncology
Su, H. Irene, MD, et al.
“Fertility Preservation in People With Cancer: ASCO Guideline Update”
(Full text. Published: March 19, 2025)
https://ascopubs.org/doi/pdf/10.1200/JCO-24-02782
Mayo Clinic
“Fertility preservation: Understand your options before cancer treatment”
(March 7, 2024)
https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/fertility-preservation/art-20047512
Memorial Sloan Kettering Cancer Center
“About Ovarian Tissue Freezing”
(Last updated: March 16, 2023)
https://www.mskcc.org/cancer-care/patient-education/ovarian-tissue-freezing
Up to Date
Oktay, Kutluk, MD, PhD, FACOG and Sonmezer, Murat, MD
“Fertility preservation: Cryopreservation options”
(Topic last updated: February 13, 2023)
https://www.uptodate.com/contents/fertility-preservation-cryopreservation-options
“Patient education: Preserving fertility after cancer treatment in men (The Basics)”
(Accessed: June 2, 2025)
https://www.uptodate.com/contents/preserving-fertility-after-cancer-treatment-in-men-the-basics
“Patient education: Preserving fertility after cancer treatment in Patients (The Basics)”
(Accessed: June 2, 2025)
https://www.uptodate.com/contents/preserving-fertility-after-cancer-treatment-in-Patients-the-basics
