Fertility Preservation Options Before Chemotherapy: What You Need to Know

When you’re diagnosed with cancer, your mind races through a thousand questions. But one that often gets buried under fear and urgency is this: fertility preservation. If you’re someone who might want to have children someday, chemotherapy can threaten that future - fast. And the window to act is narrow. Many people don’t realize they have options until it’s too late. The truth? You have choices. And knowing them before treatment starts can change everything.

Why Chemotherapy Can Hurt Fertility

Chemotherapy doesn’t just target cancer cells. It attacks fast-dividing cells - including those in your ovaries and testes. That’s why up to 80% of chemotherapy regimens carry a high risk of damaging reproductive tissue. For women, this often means early menopause. For men, it can mean low or zero sperm count. Some drugs, especially alkylating agents like cyclophosphamide, are especially harsh. A 2019 study found that 30-80% of women treated with these drugs develop premature ovarian insufficiency, meaning their ovaries stop working years before they should.

For men, the damage can be sudden and permanent. Even a single cycle of chemo can reduce sperm production. And if you’re under 35, you might assume you’re safe - but that’s not always true. Fertility loss isn’t always obvious right away. You might still have periods or ejaculate normally, but the quality and quantity of your eggs or sperm could be severely reduced.

Options for Women: Egg Freezing and Embryo Freezing

The two most common options for women are egg freezing and embryo freezing. Both start the same way: 10-14 days of hormone injections to stimulate your ovaries to produce multiple eggs. These injections are given daily, usually starting on day 2 or 3 of your menstrual cycle. You’ll have regular ultrasounds and blood tests to track your response.

Once the eggs are mature, they’re retrieved in a quick outpatient procedure under light sedation. A thin needle is guided through the vagina to collect the eggs from the ovaries. Then, they’re frozen using a technique called vitrification - a rapid freeze that prevents ice crystals from forming and damaging the cells. Survival rates for frozen eggs are now 90-95%.

If you have a partner or plan to use donor sperm, you can fertilize the eggs right away to create embryos. Embryo freezing has slightly higher success rates. For women under 35, each frozen embryo has a 50-60% chance of leading to a live birth. Egg freezing is close behind, with a 45-55% live birth rate per embryo created from frozen eggs. But here’s the catch: you need to freeze a lot of them. Experts say you’ll want at least 15-20 mature eggs to have a good shot at one baby.

What If You Don’t Have Time for Hormone Shots?

Not everyone can wait 10-14 days. Some cancers - like leukemia - need treatment right away. That’s where ovarian tissue cryopreservation comes in. This is the only option for prepubertal girls and women who can’t delay chemo. Surgeons remove a small piece of ovarian tissue (about the size of a thumbnail) through a minimally invasive laparoscopic procedure. The tissue, which contains thousands of immature eggs, is frozen and stored.

Years later, if you’re in remission and ready to have a child, the tissue can be thawed and re-implanted. In some cases, it starts working again - producing hormones and even releasing eggs naturally. Success rates for restoring ovarian function are 65-75%. There have been over 200 live births worldwide from this method as of 2023. It’s still considered experimental by the FDA, but it’s now widely available in major cancer centers.

Can Hormone Shots Help Protect Your Ovaries?

Yes - but not as a replacement. Gonadotropin-releasing hormone agonists (GnRHa), like goserelin (Zoladex), are monthly injections that temporarily shut down your ovaries during chemotherapy. Think of it like hitting pause. This doesn’t guarantee you’ll stay fertile, but it can reduce your risk of early menopause by 15-20%, according to the 2015 POEMS trial. It’s often used alongside egg freezing, not instead of it.

The downside? Side effects. Many women report severe hot flashes, night sweats, and vaginal dryness. One survey found 31% of women stopped taking the drug because the symptoms were too hard to live with. It’s not a magic shield - but for some, it’s a helpful layer of protection.

Options for Men: Sperm Banking

For men, the process is simpler and faster. You just need to produce a semen sample - usually after 2-3 days of abstinence. It’s collected in a private room at a fertility clinic or hospital. The sample is processed, mixed with a cryoprotectant solution (usually 7% glycerol), and frozen in liquid nitrogen. Most clinics store multiple samples in case you need more than one round of IVF later.

Post-thaw sperm motility averages 40-60%, which is enough for successful IVF or IUI. Even if your count drops after chemo, frozen sperm from before treatment remains viable indefinitely. There’s no time limit. Men who banked sperm 20 years ago have successfully fathered children.

The challenge? Many men feel embarrassed or overwhelmed. Some don’t even know it’s an option. Others are too sick to produce a sample on short notice. The key? Do it early. Ideally, within 72 hours of diagnosis. The American Urological Association says sperm quality can decline rapidly once chemo starts.

Radiation Shielding: A Hidden Tool

If you’re getting radiation therapy to the pelvic area - common for cervical, rectal, or prostate cancer - there’s a simple way to protect your reproductive organs. Custom-made lead shields can block up to 90% of scattered radiation from reaching your ovaries or testes. This doesn’t help with chemo damage, but it’s a powerful tool when radiation is part of your plan.

Radiation oncologists routinely use these shields. But not all patients know to ask. If you’re scheduled for pelvic radiation, ask your care team: “Can you shield my reproductive organs?” It’s a quick, painless step that can make a big difference.

What About Kids?

For children and teens, options are limited - but not gone. Girls under 12 can’t freeze eggs because their ovaries aren’t mature enough. But ovarian tissue cryopreservation is the standard of care for them. Boys can’t bank sperm until puberty, but testicular tissue freezing is being studied in clinical trials. It’s still experimental, but promising. In 2023, researchers successfully grew immature sperm cells from frozen testicular tissue in the lab - a major step toward future fertility restoration for young boys.

Timing Is Everything

The biggest reason people miss out on fertility preservation? Delay. Only 37% of eligible patients complete any form of preservation before starting chemo. Why? Treatment moves fast. Insurance gets in the way. Doctors don’t bring it up. Patients don’t know to ask.

The rule of thumb? Get referred to a reproductive specialist within 14 days of diagnosis. For acute cancers like leukemia, you might have only 48-72 hours. That’s why some hospitals now use “random-start” protocols - you can begin hormone stimulation at any point in your cycle, cutting the wait time to under two weeks.

Costs, Insurance, and Access

Fertility preservation isn’t cheap. Egg freezing can cost $8,000-$15,000. Sperm banking is cheaper - around $500-$1,000 for the initial process, plus $300-$500 a year to store. Ovarian tissue freezing runs $10,000-$12,000.

Insurance coverage varies wildly. Twenty-four U.S. states now require insurers to cover fertility preservation for cancer patients. But in many places, including parts of Australia, coverage is patchy. Medicaid covers it in only 12 states. Rural patients often drive over 170 miles to reach a fertility center. And if you’re single, LGBTQ+, or under 18, you might face extra barriers.

Don’t assume you can’t afford it. Many clinics offer payment plans. Nonprofits like Fertile Hope and Livestrong provide grants. Ask your oncology social worker - they know where to look.

Emotional Weight and Regret

This isn’t just a medical decision. It’s emotional. A 2022 study found 68% of women who didn’t pursue fertility preservation later felt regret - especially if treatment was delayed by more than three weeks. Reddit threads from people with breast cancer show common fears: “What if I never have kids?” “What if my partner leaves me?” “What if I’m too tired to go through this?”

But there are success stories. A 32-year-old woman with BRCA1+ breast cancer had her ovarian tissue frozen before chemo. Five years later, after being cancer-free, it was transplanted back. She gave birth to twins. That’s not common - but it’s possible.

What’s Next?

The field is moving fast. In 2023, the FDA approved a new closed-system vitrification device that cuts contamination risk by 92%. Researchers are testing “artificial ovaries” - lab-grown structures that can hold and mature eggs outside the body. One NIH-funded trial is already seeing 68% follicle survival in primates.

The goal? Make fertility preservation standard - not optional. Because surviving cancer shouldn’t mean giving up on your future family.