Fertility Preservation Before Chemotherapy: What You Need to Know

Why Fertility Preservation Matters Before Chemotherapy

Chemotherapy doesn’t just fight cancer-it can also stop your body from having children later. For many people, especially those under 40, this is a devastating side effect they never saw coming. About 80% of common chemotherapy drugs damage the ovaries or testes, leading to early menopause or permanent infertility. That’s not a rare risk-it’s the norm for breast cancer, lymphoma, leukemia, and many other treatments. The good news? You don’t have to accept this as inevitable. Fertility preservation isn’t optional anymore; it’s a standard part of cancer care. And the sooner you act, the better your chances.

What Options Are Actually Available?

There are six proven ways to protect your fertility before starting chemotherapy. Not all apply to everyone, but knowing your choices helps you make the right call under pressure.

• Sperm banking is the simplest and most reliable option for men. After 2-3 days without ejaculation, a sample is collected and frozen. Post-thaw, 40-60% of sperm usually remain active. It takes less than a day to complete, and the results last indefinitely.
• Egg freezing (oocyte cryopreservation) is the go-to for women without a partner. It starts with 10-14 days of daily hormone injections to stimulate egg production. Then, eggs are retrieved under light sedation. Vitrification (ultra-rapid freezing) now gives you a 4-6% chance of pregnancy per egg. Most women need to freeze 15-20 eggs for a decent shot at a baby later.
• Embryo freezing has the highest success rate-50-60% live birth rate per transfer for women under 35. But it requires sperm, either from a partner or donor. If you’re single or in a same-sex relationship, this isn’t an option unless you’re open to donor sperm.
• Ovarian tissue cryopreservation is the only choice for girls who haven’t hit puberty or women who can’t delay treatment. Surgeons remove and freeze small pieces of ovarian tissue. Later, it can be reimplanted. Over 200 babies have been born this way worldwide. It’s still considered experimental by the FDA, but it’s the only hope for preteen cancer patients.
• Ovarian suppression uses monthly hormone shots (like goserelin) to put your ovaries into temporary hibernation during chemo. Studies show it cuts the risk of early menopause by 15-20%. It doesn’t guarantee fertility, but it helps. Side effects? Think hot flashes, night sweats, and vaginal dryness-like menopause on fast-forward.
• Radiation shielding only applies if you’re getting pelvic radiation. A custom lead shield can block 50-90% of radiation from reaching your ovaries or testes. It does nothing against chemo damage, but it’s a smart add-on if you’re getting both.

Timing Is Everything-And It’s Tight

You have a narrow window. For women, egg freezing can’t start until after your period begins. The whole process takes 10-14 days. But if your cancer is aggressive-like acute leukemia-you might only have 48 to 72 hours before chemo starts. That’s why some clinics now use “random-start” protocols. Instead of waiting for your cycle, they begin hormone treatment right away. This cuts the delay to just 11 days on average.

For men, sperm banking is faster. You can do it in one visit, even the day before chemo. But if you’re too sick or in pain, collection can be tough. That’s why some doctors recommend banking sperm as soon as diagnosis is confirmed-even before treatment planning is final.

Delaying treatment for fertility reasons is risky. In fast-moving cancers, even two extra weeks can raise relapse risk by 5-10%. That’s why experts say: Don’t wait for the perfect plan. Do what’s possible, when it’s possible.

What Doesn’t Work (And Why People Regret It)

Many patients assume they’ll be offered fertility options automatically. They’re wrong. Only 37% of eligible patients complete any form of preservation before chemo starts. Why? Three big reasons:

1. No one told them. A 2022 study at MD Anderson found 68% of women aged 18-35 regretted not freezing eggs or embryos because they weren’t given time or information.
2. Insurance denied coverage. In the U.S., 42% of women reported being turned down for egg freezing. Even in states with mandates, insurers often find loopholes.
3. They thought they’d be fine. Many assume they’re too young to lose fertility. But chemo doesn’t care about age. A 28-year-old can go into early menopause just like a 42-year-old.

One woman in her late 20s, diagnosed with breast cancer, was told she “could always adopt.” She didn’t pursue egg freezing. Five years later, she’s cancer-free but heartbroken over her lost chance to have a biological child. Her story isn’t rare.

Cost, Access, and the Hidden Barriers

Fertility preservation isn’t cheap. Egg freezing can cost $10,000-$15,000 per cycle, plus $500-$1,000 a year to store. Sperm banking is cheaper-around $500-$1,000 upfront. But insurance coverage is patchy. Only 12 U.S. states require Medicaid to cover it. In South Africa, public hospitals rarely offer these services. Private clinics in Durban or Johannesburg may, but costs are still high.

Distance is another hurdle. Rural patients travel an average of 178 miles to reach a fertility center. Urban patients? Just 22 miles. If you’re in a small town, you might need to fly or take a bus for treatment. That’s not just inconvenient-it’s a dealbreaker for someone already overwhelmed by cancer.

What’s New and What’s Coming

Science is moving fast. In 2023, the FDA approved a new closed-system freezing device that cuts contamination risk by 92%. That’s a big win for safety. Researchers are also testing “in vitro activation”-a way to wake up frozen ovarian tissue in the lab so it doesn’t need to be reimplanted. This could be huge for women with BRCA mutations who worry about reinserting tissue that might carry cancer risk.

Another breakthrough? Artificial ovaries. A $4.7 million NIH trial is testing lab-grown ovaries made from stem cells. In monkeys, they’ve kept follicles alive for months. Human trials could start by 2027.

And the numbers are growing. The global fertility preservation market hit $1.87 billion in 2022 and is expected to grow over 12% yearly. More hospitals are adding oncofertility teams. But progress isn’t even. The gap between rich and poor, urban and rural, insured and uninsured is still wide.

What You Should Do Right Now

If you or someone you love is facing chemotherapy:

• Ask your oncologist immediately if your treatment plan affects fertility. Don’t wait for them to bring it up.
• Request a referral to a reproductive endocrinologist who works with cancer patients. These specialists know the timing, the protocols, and the insurance tricks.
• Don’t assume you have time. Even if your chemo is weeks away, start the conversation now. Some steps can be done in parallel with cancer planning.
• Check your insurance. Call your provider. Ask: “Do you cover fertility preservation for cancer patients?” If they say no, ask for the denial in writing. You might appeal.
• Consider all options. Even if you’re single, don’t rule out egg freezing. Even if you’re young, don’t assume you’re safe. Even if you’re scared, don’t skip it. This isn’t about having a baby tomorrow-it’s about keeping the option alive.

There’s no perfect solution. But there are better ones than doing nothing. Fertility preservation isn’t a luxury. It’s part of healing.

Real Stories, Real Outcomes

A 32-year-old woman with BRCA1 mutations had a double mastectomy and chemo for breast cancer. She froze her ovarian tissue before treatment. Five years later, after being cancer-free, doctors reimplanted the tissue. She got pregnant naturally. She gave birth to twins.

A 19-year-old boy with Hodgkin’s lymphoma banked sperm the day after his diagnosis. He finished chemo in six months. Three years later, he and his partner used IVF. Their daughter was born healthy.

These aren’t miracles. They’re results of planning, access, and courage.