{"entity":{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","aka":[],"tldr":"Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.","summary":"Alkylators, pelvic radiation, transplant conditioning and some targeted drugs cause infertility; ASCO (2006, updated 2018) recommends discussing fertility with every patient of reproductive age before treatment. Options: sperm banking (standard, cheap), oocyte or embryo cryopreservation (random-start stimulation within 2 weeks; letrozole protocols for ER+ breast cancer), ovarian tissue cryopreservation (no longer experimental per ASRM 2019; >200 live births; the only option for prepubertal girls), GnRH agonist during chemotherapy (reduces premature ovarian insufficiency in breast cancer, POEMS/PROMISE; not fertility-proven), ovarian transposition before pelvic radiation, testicular tissue banking (experimental), and uterine transplantation. Pregnancy after breast cancer is safe (POSITIVE trial 2023: interrupting endocrine therapy for pregnancy did not increase recurrence at 3 years). Access is limited by cost, time pressure and referral rates (<50% of eligible patients counselled).","status":"established","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Oncofertility","links":[{"label":"ASCO fertility preservation guideline 2018","url":"https://doi.org/10.1200/JCO.2018.78.1914"},{"label":"POSITIVE trial (NEJM 2023)","url":"https://doi.org/10.1056/NEJMoa2212856"},{"label":"Oncofertility Consortium","url":"https://oncofertility.msu.edu/"},{"label":"Cancer Research UK: preserving fertility with breast cancer","url":"https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/preserving-fertility"},{"label":"Macmillan: fertility","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/fertility"},{"label":"NICE NG101: early and locally advanced breast cancer, recommendations (updated 2025)","url":"https://www.nice.org.uk/guidance/ng101/chapter/Recommendations"},{"label":"Bowel Cancer UK: fertility","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/fertility/"},{"label":"NICE NG257: fertility problems, fertility preservation for medical indications (2026)","url":"https://www.nice.org.uk/guidance/ng257/chapter/Fertility-preservation-for-medical-indications"},{"label":"Moore et al., goserelin for ovarian protection during breast cancer adjuvant chemotherapy, POEMS/S0230 (NEJM 2015)","url":"https://doi.org/10.1056/NEJMoa1413204"},{"label":"Lambertini et al., GnRH agonists during chemotherapy for preservation of ovarian function and fertility, individual patient-level meta-analysis of 873 patients (JCO 2018)","url":"https://doi.org/10.1200/JCO.2018.78.0858"},{"label":"Lymphoma Action: reduced fertility","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/reduced-fertility"},{"label":"Lymphoma Action: early menopause and lymphoma","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/early-menopause-and-lymphoma"},{"label":"Behringer et al., gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials, Journal of Clinical Oncology 2013 (1,323 survivors)","url":"https://doi.org/10.1200/JCO.2012.44.3721"}],"tags":["gap-fill","supportive","aya"],"related":[],"cancers":["breast-hr-positive","hodgkin-lymphoma","testicular","all-leukemia","cervical","endometrial","tnbc","colorectal","breast-cancer","non-hodgkin-lymphoma","dlbcl","follicular-lymphoma","mantle-cell-lymphoma","marginal-zone-lymphoma","malt-lymphoma","splenic-marginal-zone-lymphoma","nodal-marginal-zone-lymphoma","waldenstrom","primary-mediastinal-b-cell-lymphoma","burkitt-lymphoma","early-stage-classical-hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma","relapsed-refractory-hodgkin-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","peripheral-t-cell-lymphoma","angioimmunoblastic-t-cell-lymphoma","cutaneous-t-cell-lymphoma","sezary-syndrome","primary-cns-lymphoma"],"sections":["supportive-care","rejuvenation"],"technologies":["survivorship-care-plan","endocrine-therapy","ovarian-function-after-chemotherapy","testosterone-after-cancer-treatment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["ovarian-function-suppression","aya-oncology","cancer-in-pregnancy"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-partridge-n-engl-j-med","paper-oktay-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":["Triple-negative breast cancer is more common under 40, and chemotherapy usually starts within weeks of diagnosis. Cancer Research UK says national guidelines expect the team to discuss fertility at diagnosis, that egg or embryo freezing takes about 2 to 3 weeks, that ovarian tissue freezing is available in a growing number of UK centres, and that NHS funding varies by area. Because this cancer has no hormone receptors, there is no endocrine therapy to interrupt afterwards; the question is protecting eggs before the first cycle.","Bowel cancer: Bowel Cancer UK says some treatments affect fertility and the team should discuss the risk at diagnosis, that radiotherapy to the pelvis will often cause infertility and early menopause and will affect the uterus so that pregnancy is not possible even with fertility treatment, that chemotherapy can cause temporary or permanent infertility depending on the drugs and doses, and that both men and women should use contraception during radiotherapy and chemotherapy and for about a year afterwards.","Breast cancer in the UK: NICE NG101 (1.1.5) sends fertility preservation to the NICE fertility guideline, now NG257 (2026). NG257 (1.53.1) says to discuss fertility preservation with people preparing for medical treatment likely to impair their fertility, and that for people who need urgent treatment this discussion should take place at the earliest possible opportunity; (1.53.5) to offer sperm cryopreservation and (1.53.6) oocyte or embryo cryopreservation to people of reproductive age; and (1.53.7) to consider ovarian tissue cryopreservation where those are not feasible.","The funding sentence most people are never told: NG257 (1.53.3) says that for NHS-funded fertility preservation, do not apply the eligibility criteria used for conventional fertility treatment, including the lower age limit. NG257 (1.53.4) adds that those criteria will apply when it comes to using the stored material, and (1.53.8) that storage is reviewed at least every 5 years with continued NHS funding for people who remain at significant risk of infertility.","Timing and the alternative. Cancer Research UK says egg collection and freezing takes about 2 to 3 weeks, that letrozole or tamoxifen can be combined with lower-dose IVF hormones, and that IVF is available for some people on the NHS but not in all parts of the country. Where there is no time, switching the ovaries off during chemotherapy is the other route: in an individual patient-level meta-analysis of 873 patients from five trials, premature ovarian insufficiency occurred in 14.1 percent given a GnRH agonist against 30.9 percent of controls (adjusted odds ratio 0.38) and post-treatment pregnancy in 10.3 against 5.5 percent, with no significant difference in disease-free or overall survival.","Lymphoma: Lymphoma Action says fertility preservation is generally more effective when begun before treatment, that sperm must be banked beforehand, and that egg freezing and embryo storage involve about two weeks of daily injections before the eggs are collected. It quotes NICE as saying there should be no lower age limit on who is offered preservation, that it may be available up to age 40 and that this varies across the NHS, and that the impact on fertility should be discussed at diagnosis. Because aggressive lymphoma is often treated within days, the number of days available before treatment must start is the question the decision turns on."],"principle":"Time-critical referral to reproductive specialists before gonadotoxic therapy, with the preservation method chosen by sex, age, pubertal status, cancer type, time available and hormone sensitivity.","strengths":["Established live-birth outcomes for sperm, oocyte, embryo and ovarian tissue","Random-start protocols avoid treatment delay","POSITIVE trial reassures about pregnancy after breast cancer"],"limitations":["Cost and insurance coverage (mandated in only some US states)","Prepubertal boys have only experimental options","Referral gaps, especially in men, adolescents and LMICs"],"since":2006},"route":"/technologies/fertility-preservation/","neighbours":{"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"aya-cancers","kind":"cancer","name":"Adolescent and young adult cancers (ages 15 to 39)","route":"/cancers/aya-cancers/"},{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"cutaneous-t-cell-lymphoma","kind":"cancer","name":"Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)","route":"/cancers/cutaneous-t-cell-lymphoma/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-stage-classical-hodgkin-lymphoma/"},{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"gestational-trophoblastic","kind":"cancer","name":"Gestational trophoblastic neoplasia","route":"/cancers/gestational-trophoblastic/"},{"id":"neuroblastoma-high-risk","kind":"cancer","name":"High-risk neuroblastoma","route":"/cancers/neuroblastoma-high-risk/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"neuroblastoma-intermediate-risk","kind":"cancer","name":"Intermediate-risk neuroblastoma","route":"/cancers/neuroblastoma-intermediate-risk/"},{"id":"low-risk-gtn","kind":"cancer","name":"Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6)","route":"/cancers/low-risk-gtn/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"pancreatoblastoma","kind":"cancer","name":"Pancreatoblastoma","route":"/cancers/pancreatoblastoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"placental-site-trophoblastic-tumour","kind":"cancer","name":"Placental-site trophoblastic tumour and epithelioid trophoblastic tumour","route":"/cancers/placental-site-trophoblastic-tumour/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"sezary-syndrome","kind":"cancer","name":"Sezary syndrome","route":"/cancers/sezary-syndrome/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"vaginal-adenocarcinoma","kind":"cancer","name":"Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma)","route":"/cancers/vaginal-adenocarcinoma/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-ayac-distinct-group","kind":"technology","name":"Adolescents and young adults: a group with its own cancers, its own gap and its own needs","route":"/technologies/rejuv-ayac-distinct-group/"},{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","route":"/technologies/rejuv-tx-what-to-ask-for/"},{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/"},{"id":"rejuv-paed-fertility-male","kind":"technology","name":"Fertility in boys and young men treated for cancer, including testicular tissue banking","route":"/technologies/rejuv-paed-fertility-male/"},{"id":"rejuv-paed-fertility-female","kind":"technology","name":"Fertility in girls and young women treated for cancer, including ovarian tissue freezing","route":"/technologies/rejuv-paed-fertility-female/"},{"id":"rejuv-tx-fertility-and-growth","kind":"technology","name":"Fertility, growth and what total body irradiation costs","route":"/technologies/rejuv-tx-fertility-and-growth/"},{"id":"ovarian-function-after-chemotherapy","kind":"technology","name":"Ovarian function after chemotherapy: who recovers, and when","route":"/technologies/ovarian-function-after-chemotherapy/"},{"id":"rejuv-ayac-services","kind":"technology","name":"Services built for teenagers and young adults, and what the national evaluation found","route":"/technologies/rejuv-ayac-services/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"testosterone-after-cancer-treatment","kind":"technology","name":"Testosterone after cancer treatment in men","route":"/technologies/testosterone-after-cancer-treatment/"},{"id":"rejuv-recovery-cumulative-dose","kind":"technology","name":"The cumulative dose that decides whether it comes back","route":"/technologies/rejuv-recovery-cumulative-dose/"},{"id":"rejuv-access-what-it-costs-uk","kind":"technology","name":"What recovery costs in the UK, and what it does not","route":"/technologies/rejuv-access-what-it-costs-uk/"},{"id":"rejuv-access-what-it-costs-us","kind":"technology","name":"What recovery costs in the United States","route":"/technologies/rejuv-access-what-it-costs-us/"},{"id":"rejuv-access-fertility-preservation","kind":"technology","name":"Who gets told about fertility before treatment, and who does not","route":"/technologies/rejuv-access-fertility-preservation/"}],"term":[{"id":"aya-oncology","kind":"term","name":"Adolescent and young adult (AYA) oncology","route":"/terms/aya-oncology/"},{"id":"cancer-in-pregnancy","kind":"term","name":"Cancer during pregnancy","route":"/terms/cancer-in-pregnancy/"},{"id":"lymphoma-decision-beacopp-or-abvd","kind":"term","name":"Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed","route":"/terms/lymphoma-decision-beacopp-or-abvd/"},{"id":"lymphoma-tx-fertility-preservation","kind":"term","name":"Fertility before lymphoma treatment: what to ask for, and when","route":"/terms/lymphoma-tx-fertility-preservation/"},{"id":"lymphoma-decision-fertility-timing","kind":"term","name":"Fertility preservation before lymphoma treatment: a decision with a deadline in days","route":"/terms/lymphoma-decision-fertility-timing/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"ovarian-function-suppression","kind":"term","name":"Ovarian function suppression (OFS)","route":"/terms/ovarian-function-suppression/"},{"id":"sex-fertility-after-bowel-cancer","kind":"term","name":"Sexual function, fertility and body image after bowel cancer","route":"/terms/sex-fertility-after-bowel-cancer/"}],"paper":[{"id":"paper-oktay-j-clin-oncol","kind":"paper","name":"Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update","route":"/key-papers/paper-oktay-j-clin-oncol/"},{"id":"paper-partridge-n-engl-j-med","kind":"paper","name":"Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer","route":"/key-papers/paper-partridge-n-engl-j-med/"}],"roadmap":[{"id":"paediatric-oncology-roadmap","kind":"roadmap","name":"Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first","route":"/roadmaps/paediatric-oncology-roadmap/"},{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}