Hearing that you have cancer is overwhelming, and thoughts about having children one day can seem secondary. Yet some cancer treatments can permanently damage the ovaries or testes, and the window to protect fertility is often only the few weeks before treatment begins. Oncofertility preservation is the branch of fertility care that works alongside your cancer team to store eggs, embryos, sperm or tissue before that window closes. If you or a family member are facing chemotherapy, radiation or surgery, please read this quickly and ask your oncologist about a referral. You can also learn about our oncofertility preservation services directly.
Why oncofertility preservation is urgent
The single most important message is to ask early. A fertility consultation can usually be arranged within a day or two, and egg or embryo freezing typically takes around two weeks from the first injection. In most cases this can be done without meaningfully delaying cancer treatment, provided the fertility team is involved at the time of diagnosis rather than after the first chemotherapy cycle has begun. International guidance from oncology and fertility societies recommends that every patient of reproductive age be told about fertility risks and offered referral before treatment starts.
How cancer treatment can affect fertility
- Chemotherapy, especially alkylating drugs such as cyclophosphamide, can destroy eggs in the ovary and sperm-producing cells in the testes. The risk depends on the drug, total dose and age.
- Radiation to the pelvis, abdomen or testes can damage the ovaries, uterus or testicles; radiation to the brain can affect the hormones that control fertility.
- Surgery may remove reproductive organs, as in some ovarian, uterine or testicular cancers.
- Hormonal and targeted therapies may not damage eggs directly, but treatment lasting several years means a woman will be older when she is ready to try for a pregnancy.
Some people keep their fertility after treatment, but it is very hard to predict in advance who will, which is why preservation is offered before treatment.
Fertility preservation before chemotherapy: options for women
Egg freezing
The ovaries are stimulated with hormone injections for about 10–12 days, the eggs are collected under light anaesthesia, and mature eggs are vitrified. This is the preferred choice for women without a partner, or who want to keep the decision about future use in their own hands. We explain the process in detail in our guide to oocyte freezing.
Embryo freezing
Women with a partner can have their eggs fertilised and freeze the resulting embryos. Embryos survive freezing well, but their future use requires both partners’ consent, which deserves careful thought.
Random-start ovarian stimulation
Traditionally, stimulation started at the beginning of a period, which could mean waiting several weeks. With random-start ovarian stimulation, injections can begin on almost any day of the cycle, and published studies show egg numbers comparable to conventional starts. This has greatly shortened the time needed. Where time allows, two back-to-back stimulations can sometimes be done to store more eggs.
Protocols for hormone-sensitive cancers
In oestrogen-receptor-positive breast cancer, there is concern about the high oestrogen levels stimulation produces. A widely used approach adds letrozole, a tablet that lowers oestrogen, to the stimulation medication. Evidence so far has not shown that this approach worsens cancer outcomes, but the plan is always made together with your oncologist.
Ovarian tissue freezing
When there is no time for stimulation, or for girls who have not yet reached puberty, a piece of ovarian tissue can be removed by laparoscopy and frozen. Later it can be grafted back to restore hormone production and fertility. This technique is offered at a limited number of specialised centres, and it may not be suitable when there is a risk of cancer cells in the ovary, such as in some leukaemias. We can advise whether it is worth exploring and help with onward referral.
Ovarian transposition
When pelvic radiation is planned, for example for cervical or rectal cancer, a surgeon can sometimes move the ovaries out of the radiation field by laparoscopy. This can protect ovarian function from the radiation, although it does not protect against chemotherapy and the uterus may still be affected. It is often combined with egg or embryo freezing.
GnRH agonist injections
Some oncologists give monthly GnRH agonist injections during chemotherapy to quieten the ovaries. Evidence suggests this may reduce the risk of premature ovarian failure in some women, particularly with breast cancer, but it is not a reliable substitute for freezing eggs or embryos. It can be used in addition, not instead.
Sperm banking before cancer treatment: options for men
For men and adolescent boys who have gone through puberty, sperm banking is simple, quick and well established. Semen samples are produced by masturbation and frozen, ideally before the first dose of chemotherapy, because even one treatment can damage sperm DNA. Two or three samples a couple of days apart give a better reserve if time allows, but even a single sample is worthwhile.
If the semen contains no sperm, or a sample cannot be produced, sperm can sometimes be retrieved surgically from the testis and frozen. Our male infertility team, including andrologists and a urologist, handles both banking and retrieval. Later, frozen sperm is usually used with ICSI, since the number of sperm stored may be limited.
Children and adolescents
Young patients need particular sensitivity. Teenage boys who can produce a semen sample can bank sperm. For girls after puberty, egg freezing may be possible. For children before puberty, the only options are ovarian or testicular tissue freezing; testicular tissue freezing is still considered experimental, and ovarian tissue freezing is available only at specialised centres. Decisions are made with parents and, as far as possible, with the young person, with counselling for the whole family.
Coordinating with your oncologist
Good oncofertility care depends on fast, clear communication between teams. A typical sequence is:
- Your oncologist confirms the diagnosis and treatment plan and the date treatment must begin.
- You are seen by a fertility specialist, often within one or two days, with blood tests and a scan.
- Both teams agree on a safe approach, including any letrozole protocol or blood-clot precautions.
- Stimulation and egg collection, or sperm banking, are completed within the available window.
- Cancer treatment begins as planned, with the fertility team available for follow-up.
Please bring your oncologist’s notes, scan and biopsy reports, and blood counts to the first visit. Our fertility specialists will contact your cancer team directly when needed.
Emotional support and making decisions quickly
Being asked to make decisions about future children within days of a cancer diagnosis is hard. It is normal to feel rushed, unsure or even guilty for thinking about fertility at all. Our counsellor can help you and your family talk through the options, the likely chances and the costs, so that whatever you decide, you decide with clear information. Some patients choose not to preserve fertility, and that is a valid decision too. What matters is that the choice is offered and explained, not made by default because nobody raised it in time.
Partners and parents often have questions of their own, about safety, about the effect on cancer treatment and about what happens to stored samples. They are welcome to join the consultation.
After cancer: using what you have stored
When your oncologist agrees it is safe to try for a pregnancy, often after a waiting period that depends on the cancer, stored eggs, embryos or sperm can be used through IVF or ICSI. Some survivors conceive naturally and never need their stored samples. Under the ART (Regulation) Act, 2021, gametes may be stored for up to 10 years, with written consent recording your wishes. Ask about renewal and storage arrangements at the outset, and for adolescents, how consent will be updated when they turn 18. More information on all our fertility preservation options is available on our treatment page.
Talk to a Ridge IVF specialist
If treatment is about to begin, please call us the same day so we can see you quickly. Contact us to be seen at Jawahar Nagar, Fortis Shalimar Bagh or Burari, or call or WhatsApp +91 88001 00326.
This article is for general information and is not a substitute for a personal consultation with a fertility specialist.
Frequently asked questions
Will fertility preservation delay my cancer treatment?
Usually only slightly, or not at all. Sperm banking can be done within a day or two. Egg or embryo freezing typically takes about two weeks, and random-start stimulation means there is no need to wait for a period. Your oncologist decides how much time can safely be allowed, and the fertility team plans around that date rather than the other way round.
Is it safe to stimulate the ovaries if I have breast cancer?
For hormone-sensitive breast cancer, stimulation is commonly combined with letrozole, which keeps oestrogen levels much lower during the cycle. Studies so far have not shown worse cancer outcomes with this approach, though long-term data continue to grow. The decision is always made jointly with your oncologist, who knows the details of your tumour and treatment plan.
Can I still get pregnant if I did not freeze eggs before treatment?
Possibly. Some women keep ovarian function after chemotherapy, depending on the drugs used and their age. However, the reserve may be reduced, and menopause can come earlier, so a fertility assessment after treatment is wise. If natural conception is not possible, options such as IVF with donor eggs can be discussed once your oncologist confirms it is safe.
How many semen samples should a man bank before chemotherapy?
Two or three samples, each produced after a couple of days of abstinence, give a useful reserve and allow several future attempts at IVF or ICSI. If treatment must start urgently, even a single sample is worth freezing. Ideally all samples are collected before the first chemotherapy dose, as treatment can quickly affect sperm quality and DNA.
The information on this website is for general education and does not replace a consultation. Treatment plans and outcomes differ from person to person; no treatment can guarantee pregnancy or a live birth.
