A cancer diagnosis compresses every decision into a matter of days — and one of the most consequential is easy to miss. Chemotherapy, radiation and some surgeries can permanently reduce or end the ability to have biological children, and the window to protect that ability usually closes the moment treatment begins. Oncofertility closes this gap: the coordination between oncology and reproductive medicine that lets patients preserve their fertility before therapy starts. Here is what the options are, what the published outcomes show, and how to move fast enough to keep them open.

What is oncofertility?

Oncofertility is the bridge between cancer care and reproductive health: as soon as a diagnosis is made, the oncology team assesses how the planned treatment is likely to affect the reproductive system and — if there is any risk — refers the patient to a fertility specialist before therapy begins.

In its 2025 guideline update, drawing on 166 studies published between 2013 and 2024, the American Society of Clinical Oncology (ASCO) recommends that clinicians discuss reproductive risk and preservation options with every patient of reproductive age at diagnosis, and — for the first time — that fertility preservation be formally built into survivorship care after treatment as well.

How cancer treatment affects fertility

According to the U.S. National Cancer Institute, the risk depends on the type of treatment, its dose and duration, the patient’s age, and whether the tumour sits near reproductive organs. Alkylating chemotherapy agents carry a high risk of damaging germ cells. Radiation to the pelvis, abdomen or central nervous system can damage the ovaries or testes directly, or disrupt the pituitary and hypothalamic hormones that drive reproduction. High-dose conditioning before a stem-cell transplant is particularly gonadotoxic, and surgery for reproductive, colorectal or bladder cancers can affect fertility structurally. Some cancers reduce fertility before treatment even starts — men diagnosed with testicular cancer or Hodgkin lymphoma often have low sperm counts at diagnosis.

Fertility preservation options for women

• Oocyte (egg) freezing — eggs are collected after ovarian stimulation and vitrified. No partner or donor sperm is required.
• Embryo freezing — collected eggs are fertilised before freezing; requires a partner or donor sperm.
• Ovarian tissue cryopreservation (OTC) — a piece of ovarian cortex is removed surgically, frozen, and re-transplanted after recovery. It requires no hormonal stimulation and no delay, which makes it the main option for prepubertal girls and for patients who must start treatment immediately.
• In vitro maturation (IVM) — immature eggs are collected and matured in the laboratory. ASCO’s 2025 update moved IVM from experimental to a recommended emerging option for selected patients.
• Ovarian transposition and shielding — surgically moving the ovaries out of the radiation field, or shielding them, where pelvic radiotherapy is planned.
• GnRH agonists — ASCO is explicit that these should not replace established methods, though they may be offered as an adjunct in breast cancer or for menstrual suppression in oncologic emergencies.

Fertility preservation options for men

Sperm banking is the most common and most effective method for males who have been through puberty; samples can be frozen indefinitely and later used in IVF. Where a sample cannot be produced, surgical retrieval — testicular sperm extraction (TESE/microTESE) or aspiration (TESA) — can recover sperm directly from testicular tissue, sometimes during cancer surgery itself. Testicular shielding protects against scatter radiation during pelvic treatment. For prepubertal boys, testicular tissue freezing is available in the setting of clinical trials.

What the published outcomes show

Results are meaningful but should be read as probabilities, not promises. A systematic review and meta-analysis in Human Reproduction (2023) reported live birth rates of approximately 41% after embryo cryopreservation and 32% after oocyte cryopreservation in women who preserved fertility before cancer treatment or stem-cell transplantation.

For ovarian tissue, a 2024 meta-analysis of 20 studies covering 722 patients found that after ovarian tissue transplantation, ovarian function returned in 93% of women, the pregnancy rate was 44% and the live birth rate was 35%. Pregnancy rates were significantly higher in women who were under 35 at the time of freezing — age at preservation is one of the strongest predictors of success. Published reviews had already documented more than 130 live births worldwide following transplantation of cryopreserved ovarian tissue, and the total continues to rise as the technique moves out of the experimental category.

The timing question — and why it is less of a barrier than it used to be

The most common reason patients skip fertility preservation is fear of delaying cancer treatment. Conventional egg or embryo freezing once required waiting for a specific point in the menstrual cycle, stretching the process to two to four weeks. Random-start ovarian stimulation removed that constraint: stimulation can begin at any point in the cycle, so freezing can typically be completed within about two weeks of the first consultation. Published studies report comparable numbers of mature eggs to conventional protocols, and in the neoadjuvant breast cancer setting it appears unlikely to delay chemotherapy. Ovarian tissue freezing and sperm banking can be arranged faster still.

What to expect

The pathway starts with an urgent referral to a reproductive specialist, ideally within days of diagnosis. Expect a baseline assessment (hormone levels and ovarian reserve for women, semen analysis for men), a discussion of which methods suit the diagnosis, and coordination with the oncology team on timing. Egg and embryo freezing involve daily injections and a short outpatient retrieval under sedation; ovarian tissue retrieval is a laparoscopic day procedure; sperm banking usually takes one to three visits. Cost and insurance coverage vary widely by country, and the more specialised techniques are concentrated in a limited number of centres.

One finding is worth holding on to: NCI notes that survivors reported less regret when they had met a fertility specialist — regardless of whether they ultimately chose to preserve. The consultation itself has value.

Accessing oncofertility care with Medical E-Aid

Oncofertility depends on two things happening at once: cancer treatment planned without delay, and fertility preservation arranged in parallel at a centre equipped to do it. Medical E-Aid coordinates access to leading, internationally accredited hospitals and reproductive medicine centres worldwide and manages that sequencing — a medical review of your case, a treatment plan and cost estimate, and support with travel, visas, interpretation and follow-up. Our AI pre-screening helps route your case to the right specialists quickly, which matters most when the window is measured in days.

This article is for general information only and is not medical advice. Fertility preservation suitability depends on each patient’s diagnosis, treatment plan and reproductive status, and must be determined by qualified oncology and reproductive specialists. Outcome figures are drawn from published clinical studies and may not reflect individual results.

Sources: National Cancer Institute (NIH) — Male Fertility and Cancer Treatment (2025); ASCO, “Fertility Preservation in People With Cancer: ASCO Guideline Update,” Journal of Clinical Oncology (2025); Fraison et al., Human Reproduction (2023); Wang et al., Chinese Medical Journal (2024); “Random start ovarian stimulation for fertility preservation appears unlikely to delay initiation of neoadjuvant chemotherapy for breast cancer,” Human Reproduction (2017).