What is Oncofertility? Understanding Fertility Preservation for Cancer Patients

Cancer. The word alone can freeze time. One moment you're scheduling your next vacation, meal-prepping for the week, or scrolling mindlessly through your phone. Next, you're sitting in a sterile room, being told that your body is under siege.

That’s where oncofertility steps in. It doesn’t promise to erase the chaos cancer brings, but it does fight for something the disease threatens to take without asking: your ability to choose whether or not to have children someday.

What is Oncofertility?

Oncofertility sits at the intersection of two very different but intimately connected worlds: oncology and reproductive medicine. It’s a field designed for one purpose: preserving fertility in people facing cancer.

Chemo and radiation are powerful tools in the battle for survival, but they don’t play nice with ovaries, testicles, eggs, or sperm. In some cases, they go beyond short-term damage and slam the door on future biological parenthood altogether. Oncofertility exists to stop that door from closing completely.

How Cancer Treatments Affect Reproductive Health

Chemotherapy is notorious. It attacks rapidly dividing cells, and unfortunately, your eggs and sperm fall into that category. Some drugs, like alkylating agents (cyclophosphamide being a chief culprit), are particularly aggressive. For women, they can deplete the ovarian reserve. For men, sperm count can plummet or disappear altogether.

Radiation brings its own kind of wreckage. If it’s directed at the pelvis or brain (specifically the pituitary gland), the hormonal signals that regulate your reproductive system can be disrupted or even silenced. Doses matter, but even low levels can have long-lasting effects, especially if the person is young.

And then there’s surgery. Sometimes, in the fight to remove or reduce cancer, doctors must take reproductive organs out entirely. For a woman, that could mean her ovaries or uterus. For a man, it might be a testicle or even both. The impact isn’t just physical. It reverberates emotionally and psychologically.

This is why conversations on oncofertility are important.

Who Needs Oncofertility Treatment?

Anyone whose treatment could compromise fertility. And in many cases, that includes far more people than you’d think.

• Women and men with cancers like lymphoma, leukemia, breast, ovarian, cervical, or testicular cancer
• Patients receiving chemotherapy that may damage reproductive cells or function
• Those undergoing radiation in areas close to the reproductive system
• Anyone facing surgeries that involve reproductive organs
• Prepubescent children with cancer who may not yet have matured reproductively, but could be at risk later
• People with non-cancerous conditions like lupus or sickle cell anemia, who are being treated with fertility-damaging therapies

In short, if there’s even a flicker of possibility that your treatment might jeopardize your ability to have biological children, oncofertility should be part of your pre-treatment roadmap.

The Role of Fertility Preservation Before Treatment

Speed matters. Cancer treatment moves fast, and often, so does the window to preserve fertility.

Most oncofertility options are most effective before you begin chemo, radiation, or surgery. Why? Because once the reproductive system has been exposed to those treatments, the chances of retrieving healthy eggs or sperm drop dramatically.

This is the part of the journey where fertility specialists at FCOC work quickly, often with days, not weeks, to act. Egg retrieval cycles for women can be accelerated. Semen collection for men is usually quick and noninvasive. In some cases, even tissue can be frozen.

It’s not about vanity or indulgence. It’s about safeguarding the biological raw materials for a future you may still want to build, after the cancer battle is behind you.

Options for Women vs. Men

Every patient’s journey is unique, and so are the tools available. Here’s a breakdown by biological sex.

For Women

Women are born with a finite number of eggs. Cancer treatments can significantly accelerate egg loss or push women into premature menopause.

Here are the most commonly used preservation options:

• Egg freezing (Oocyte Cryopreservation): Your eggs are harvested, matured, and frozen unfertilized. This is ideal for women without a partner or those who want to delay embryo creation. It’s become increasingly reliable thanks to improvements in vitrification (fast freezing).
• Embryo freezing: If you do have a partner or sperm donor, fertilizing the eggs and freezing the embryos offers higher success rates. This method has been around the longest and has the most data behind it.
• Ovarian tissue freezing: A promising method for young girls and women who cannot delay treatment. A portion of ovarian tissue is removed and stored. Later, it can be reimplanted to restore hormonal function and possibly fertility.
• Ovarian suppression: Hormonal treatments like GnRH agonists aim to put the ovaries to sleep during chemotherapy. The idea is that dormant ovaries might be less vulnerable to damage. The research is mixed, and while it's not foolproof, it may help in conjunction with other methods.

For Men

The male reproductive system may seem simpler, but cancer treatments can still cause lasting damage. Here’s what males can consider:

• Sperm banking: It’s quick, relatively low-cost, and extremely effective. Ideally, multiple semen samples are collected and frozen before treatment starts.
• Testicular tissue freezing: For boys who haven't reached puberty and can’t produce sperm yet, this investigational method is their best shot. It’s still under research, but early results are hopeful.

In both cases, acting early widens the range of future possibilities.

Choosing the Right Fertility Preservation Method

This isn’t a decision you make in a vacuum. Your age, cancer type, timeline, support system, finances, and emotional state all weigh in.

Let’s say you’re 27, recently diagnosed with Hodgkin lymphoma, and you’ve always imagined having kids someday. Egg freezing could give you that chance. Or you’re a 15-year-old boy about to begin aggressive leukemia treatment, testicular tissue freezing may be the only option on the table.

And yes, finances matter. So does time. It’s hard enough to wrap your head around a cancer diagnosis, much less make major reproductive decisions in 48 hours. That’s why a coordinated team of oncologists, reproductive endocrinologists, nurses, and counselors makes all the difference. You need people who see the whole picture, not just the lab reports.

Final Thoughts

Oncofertility is more than science, and for many, it offers a lifeline in a moment when everything else feels out of reach. If you or someone you love is navigating a new cancer diagnosis, don’t wait to ask about fertility. Speak up. Demand that your future matters, not just your survival.

Cancer may threaten your body, but oncofertility helps protect your legacy.

FAQs

What is oncofertility?

Oncofertility is a specialized medical field that combines cancer treatment with reproductive medicine. Its goal is to preserve the fertility of individuals undergoing potentially damaging treatments like chemotherapy, radiation, or surgery. It involves procedures like egg and sperm freezing, embryo banking, and tissue preservation.

Does chemotherapy always cause infertility?

No, not always, but it can. The risk depends on several factors, including the drugs used, the dosage, the patient's age, and whether additional treatments are involved. Because it’s hard to predict who will be affected and how severely, it’s generally recommended to pursue fertility preservation before starting treatment.

Can I get pregnant after chemotherapy?

Possibly. Some individuals regain natural fertility post-treatment, while others may not. The outcome hinges on age, ovarian reserve, and the intensity of the treatment. A post-treatment fertility evaluation can help assess your reproductive health using hormone panels and ultrasound imaging.

Is fertility preservation covered by insurance?

It varies wildly. Some U.S. states mandate coverage for cancer-related fertility preservation, while others don’t. Some private insurers will cover it if deemed medically necessary. Regardless, many fertility clinics offer financial assistance, grants, or payment plans to offset the cost. Always consult a financial advisor or fertility coordinator early to understand your options.