IVF & Cancer: Fertility Preservation Before Treatment

IVF & Cancer: Fertility Preservation Before Treatment

Quick answer: Some cancer treatments; chemotherapy, radiotherapy, and certain surgeries can affect future fertility. Fertility preservation means storing gametes: (eggs or sperm), embryos, and ovarian/testicular tissue before treatment begins, so that having biological children may remain as a potential option in the future. It’s time-sensitive but often achievable, and in the UK it’s coordinated between your cancer team and a fertility specialist. UK guidance recommends that individuals are offered gametes (eggs or sperm) or embryo freezing, before starting anti-cancer treatment provided this can be achieved in a safe and timely manner.

A cancer diagnosis brings a great deal to absorb at once, and fertility can understandably feel like a secondary concern. From the shock of receiving the cancer diagnosis, to a whirlwind of hospital appointments, scans, tests, and reports, with more and more information building up, followed by discussions and the pressure of time-sensitive decision making., which at this time with extreme stress can be difficult to process and feel overwhelming. 

It is important to understand that in such a state of mind, patients may not retain all the information provided to them at the time and so it is helpful to have a supportive person with them and also to provide them with the team’s contact details, and written information to reflect on. Access to direct communication and dedicated support provided by their fertility preservation team facilitates this process during this short window before their potentially ‘gonadotoxic’ treatment. 

Not everyone will choose to have fertility preservation, but many people tell us afterwards that having that conversation even briefly mattered a great deal.

Why cancer treatment can affect fertility

Some treatments are described as “gonadotoxic” meaning they can harm the ovaries or testicles. Chemotherapy can reduce the number of eggs or impair sperm production; radiotherapy to the pelvic area can affect the ovaries, testicles, or uterus; and some surgeries directly affect the reproductive organs. 

This effect varies depending on the type of treatment, medication regimen used and dose, and the individual’s age, and baseline fertility. Chemotherapy can affect a person’s fertility, however, it is difficult to say how much it will be affected. Human gonads - ovaries and testicles, can take up to 2 years to recover, however, it is difficult to say if or how much they will recover and that is why a fertility follow up is offered after anti-cancer treatment. 

Moreover, the exponential rise in availability of newer targeted anti-cancer treatments, also known as immune and biological anti-cancer therapies, have further led to more referral for fertility preservation. On the positive side, they provide some control of this disease and prolong survival. However, their effects on fertility are uncertain due to lack of long term studies.

The bottom line is that not everyone will be affected by chemotherapy, and this effect is not absolute. However, its impact is difficult to predict in advance because each person’s biological make-up is unique, and so preserving fertility beforehand is a safe way to keep your options open.

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Options for Women: Females Assigned at Birth

Several approaches exist, depending on the type of cancer, how much time is available, and whether or not cancer treatment has been initiated. Modified protocols also exist for hormone sensitive cancer.

Egg freezing (oocyte cryopreservation). Eggs are collected after controlled ovarian stimulation and mature eggs are frozen unfertilised. This keeps future choices open and doesn’t require a partner or donor sperm at the time, and can be added later.

Embryo freezing. Eggs are collected, fertilised with a partner’s or donor sperm, and the resulting embryos are frozen. This is an option when you would like to involve a partner or have made a decision to use donor sperm. Embryos can be replaced into your own uterus, shared with a partner’s uterus, or replaced into a surrogate. Surrogacy is a more complex and legal process and is beyond the scope of this blog.

Ovarian tissue cryopreservation “freezing” (OTC). This involves freezing ovarian tissue to be re-implanted later. This is achieved via Key-hole surgery as a day procedure, where a whole or part of the ovary is removed and cut into strips and frozen. OTC is usually offered to those undergoing extreme treatments; such as a stem cell transplant that is known 90% of the time to wipe out ovaries. It can also be an option when there isn’t time for ovarian stimulation, and is the only option for pre-pubertal girls. This is more specialised and offered at specific centres.

It is important to distinguish that Egg and embryo freezing usually involve a short course of ovarian stimulation, about 2 - 3 weeks, and needs to be completed BEFORE initiation of chemotherapy. However, OTC can be offered during and in between cycles of chemotherapy. 

Ovarian Down-regulation (suppression): There is some beneficial role for this modality. It involves an injection given monthly or every 3-months, which will temporarily hibernate the ovary. The injection is completely reversible and Side effects include hot flushes, tiredness, low energy, and brain fog. In addition, menses will also stop but this is not a contraceptive and appropriate precaution needs to be taken.The theory is that chemotherapy affects active cells and if the ovary is quiet it may not be as much affected. However, we have no good quality randomised data to quantify this ‘protection’.

There are so many advances and growth in science. Therefore, it is worth having a discussion with a fertility preservation specialist to provide you with understanding and choices before treatment starts.

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Options for Men : Male Assigned at Birth

For men and adolescent boys, the main option is straightforward and quick.

Sperm freezing (sperm cryopreservation): A sperm sample is produced and frozen before treatment begins. It’s non-invasive, fast, and can usually be arranged without delaying cancer treatment. Where a sample can’t be produced naturally, surgical sperm retrieval may be possible. Because it’s quick, sperm freezing can often be completed in the short window or even on the same day before treatment starts.

Surgical Sperm Retrieval and OncoTese: This is an option when the ejaculate does not contain any sperm, or the person can not ejaculate to produce a sample. This involves retrieving sperm surgically via needle aspiration, or a small cut into the scrotum and sampling the testicle under a big microscope. For men with testicular cancer sperm can be retrieved from the removed testicle from areas not affected by the cancer. This is frozen and can safely be used for future fertility. 

Testicular Tissue Freezing: This involves storing testicular tissue for prepubertal boys, however, at this time there is not enough evidence to support the use of this modality.

How timing works with cancer treatment

This is the question that matters most, and the reassuring part is that it’s designed to be handled quickly. UK guidance is clear that fertility should be discussed before treatment where relevant, and referrals for preservation are treated as urgent so they don’t delay cancer care.

In practice: sperm freezing is fast and rarely affects treatment timing. Egg or embryo freezing needs a short stimulation cycle, and whether there’s time for it is a joint decision between your oncology and fertility teams. If there isn’t time, other options (such as ovarian tissue freezing) may be considered. Your health and choice remain the priority throughout the fertility preservation process provided there are no safety concerns.

The decision about what’s possible in the time available is always made with your cancer team. Fertility preservation is coordinated to fit alongside your treatment, never to delay it.

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Funding and Storage in the UK

A few things specific to the UK context:

Storage is licensed under the HFEA, usually for up to 55 years. However, consents are renewed every 10 years. The NHS funding covers fertility preservation and storage for a period of time which depends on the criteria set out by your local integrated care board (ICB). It is important to note that there is no automatic funding for future use of embryos or gametes, unless there is a reason for delayed conception. Again, this depends on certain criteria set out by local ICB authorities, which are dependent on different factors, most importantly female age, female height weight ratio (BMI), and other factors. 

It is important to highlight that most fertility centers within the UK will provide fertility treatment up to the female’s 50th birthday regardless of how many years of storage are remaining for her embryos. 

Final reminder that many individuals regain their natural fertility potential after their treatment. It is important to check with your oncologist if they are happy for you to embark on a pregnancy. 

Therefore checking with your fertility specialist and GP can be helpful in outlining your future options. 

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Frequently asked questions

Does cancer treatment always cause infertility?

No. The effect depends on the treatment type, dose, the area treated, your age,  and baseline fertility.  Some people’s fertility recovers; some is affected long-term. Because it’s hard to predict, preservation beforehand is offered to give you choices and keep options open.

How quickly can fertility preservation be done?

Sperm freezing is quick and rarely delays treatment. Egg or embryo freezing needs a short stimulation cycle (typically around two  weeks), and whether there’s time is decided jointly with your oncology team. Ovarian tissue freezing may be an option when time is very short or you have already started chemotherapy aimed towards a more extreme treatment (such as bone marrow or stem cell transplant).

Can I preserve fertility if I have hormone-sensitive breast cancer ?

Often yes. Modified stimulation protocols exist for hormone-sensitive cancers such as hormone positive breast cancers, and the approach is decided together with your cancer team to keep it as safe as possible.

Will the NHS pay for fertility preservation before cancer treatment?

In many cases the NHS funds preservation and storage for people facing fertility-affecting treatment, but this varies by area. Future treatment to use what’s stored may not be covered. Your team can tell you what applies to you.

Does preserving fertility delay cancer treatment?

It’s specifically arranged not to. Referrals are treated as urgent, sperm freezing rarely affects timing, and any egg/embryo freezing is fitted in and coordinated with your oncology team so cancer treatment stays the priority.

Do  you offer fertility preservation for non-cancerous conditions?

Only if there is a tangible risk to the ovaries or testicles, surgery, gonadotoxic agents, biologics, or more extreme treatments such as bone marrow or stem cell transplants will be carried out. For more queries you can consult your local fertility services.

Key takeaways

• There is an increasing awareness among health care practitioners and the general public towards fertility preservation evident by the growing referral cohort.
• Some cancer treatments can affect future fertility, though not everyone is affected and it’s hard to predict.
• Fertility preservation referrals are urgent, and NHS funding may apply (varies).
• Options include sperm, egg, embryo, and ovarian tissue freezing.
• Sperm freezing is quick; egg and embryo freezing need a short cycle of about 2 - 3 weeks, coordinated with your oncology team.
• In the UK storage of sperm, eggs, embryos, and tissue is HFEA licensed for up to 55 years. 
• No automatic funding for future use of stored embryos and gametes and depends on your ICB.
•  You are priority and your health and safety matter. Fertility treatment is ‘fitted’ coordinated with your cancer team to ensure best and safest outcome.
•  Early conversation with a fertility specialist can clarify what’s possible in the time available.
• You are not alone.  Supportive Counselling is available to ensure mental health and emotional needs are addressed.