A cancer diagnosis is overwhelming, and fertility may feel like the last thing to think about when treatment needs to start urgently. But many chemotherapy and radiotherapy regimens can permanently damage or destroy the ability to produce eggs or sperm — and the window to preserve fertility before treatment begins is time-limited.
This guide explains what fertility preservation options are available, when the NHS funds them, how to access them quickly, and what the realistic timeline looks like alongside cancer treatment.
Which Cancer Treatments Threaten Fertility
Not all cancer treatments are equally gonadotoxic. Understanding the risk level of the planned treatment helps prioritise whether fertility preservation is worth pursuing urgently.
High-risk treatments:
- Alkylating chemotherapy agents (cyclophosphamide, busulfan, chlorambucil, melphalan) — particularly at high doses used in bone marrow transplant conditioning
- Whole abdominal or pelvic radiotherapy
- Total body irradiation (TBI)
- Bilateral oophorectomy or orchidectomy (surgical removal of ovaries or testes)
Moderate risk:
- Some platinum-based regimens
- Radiation to fields near the reproductive organs
Lower risk (but not zero):
- Many targeted therapies and immunotherapies
- Some standard chemotherapy regimens at standard doses
Your oncology team should be able to advise on the gonadotoxic risk of your specific regimen. If they have not raised fertility preservation, it is appropriate to ask directly.
NHS Funding for Fertility Preservation
The NHS funds fertility preservation for patients facing treatments that are likely to cause permanent fertility damage. This applies regardless of age, relationship status, or whether you already have children. It is one of the clear-cut funded indications for egg or sperm freezing that sits outside the standard IVF commissioning policy.
NICE guidance (NG143) recommends that fertility preservation should be offered and funded for all patients of reproductive age before treatment that carries significant gonadotoxic risk, provided:
- The patient is of reproductive age and has not yet completed their family
- There is time to pursue preservation before treatment starts
- The patient wishes to preserve fertility
In practice, some ICBs have capacity constraints, but the principle of NHS funding for oncofertility is well-established. If your care team has not discussed fertility preservation and you want it, ask for an urgent fertility referral.
Options by Patient Type
Female Patients
Egg freezing (oocyte cryopreservation): The same stimulation process as IVF — approximately 10–14 days of injections, followed by egg collection under sedation. The eggs are frozen without fertilisation, preserving the option to use donor sperm or a partner's sperm later.
This is the most commonly used option for women without a partner, as it does not require a sperm source now.
Embryo freezing: If the patient has a partner (or is willing to use donor sperm now), embryos can be created and frozen, which has slightly higher survival rates through the freeze-thaw process than unfertilised eggs.
Ovarian tissue cryopreservation: A section of ovarian cortex is surgically removed and frozen. After treatment, the tissue can be re-implanted. This is used in cases where there is no time for stimulation before treatment must start (e.g., childhood cancers, urgent haematological malignancies). It is a more experimental technique, now offered at several specialist UK centres.
Ovarian transposition (oophoropexy): Before pelvic radiotherapy, the ovaries can be surgically moved out of the radiation field to preserve their function. This does not require harvesting eggs or tissue.
GnRH agonist co-treatment: Some oncology centres use GnRH agonist injections during chemotherapy in an attempt to "suppress" the ovaries and reduce gonadotoxic damage. The evidence for this is mixed and it is not a substitute for gamete or tissue cryopreservation.
Male Patients
Sperm banking: Producing a semen sample for cryopreservation is straightforward, quick (can be done in a single appointment), and effective. Multiple samples can be banked. This is the standard fertility preservation for post-pubertal males facing gonadotoxic treatment.
Surgical sperm extraction: For patients who cannot produce a semen sample (due to retrograde ejaculation, obstruction, or other causes), sperm can be extracted surgically from the epididymis or testis before treatment.
Testicular tissue cryopreservation: For pre-pubertal boys who cannot yet produce a semen sample, testicular tissue can be preserved. Re-implantation or in vitro maturation of cells from the tissue is experimental. This is offered at a small number of specialist UK centres.
The Urgency Problem: Timeline
A full stimulated egg or embryo freezing cycle takes approximately 14–17 days. Starting the stimulation injection can be done at any point in the menstrual cycle (or within a day or two of cycle day 1, depending on protocol), which means cycles can begin within 1–5 days of the fertility referral in many cases.
For some diagnoses, treatment cannot wait 2–3 weeks. In these cases:
- Random-start protocols allow stimulation to begin at any point in the menstrual cycle, reducing the wait to 1–2 days
- Ovarian tissue freezing can be done within days of referral, with surgery
- Sperm banking can be completed in a single day
Urgency should be communicated clearly to the fertility team at the point of referral. Most specialist oncofertility programmes understand the time pressure.
After Cancer Treatment: Using Preserved Material
Using frozen eggs, embryos, or sperm after cancer treatment is treated differently from standard IVF:
- There is no standard waiting time after cancer treatment before using preserved material, but most oncologists advise waiting until remission is confirmed and there is a period of stability before attempting pregnancy (typically 2 years for many diagnoses, though this varies significantly)
- Using preserved material is an independent decision from subsequent NHS IVF eligibility — having frozen material does not preclude you from also accessing NHS IVF if you later need it
- The thaw, fertilisation, and transfer of frozen eggs is a private treatment in most cases; the NHS funding covers the preservation itself, not necessarily subsequent use
Frequently Asked Questions
Q: Will my oncologist automatically refer me for fertility preservation?
A: Not always, despite NICE guidance. Oncologists are focused on treating cancer, and fertility may not be raised if they do not perceive it as a priority for you, or if they are under time pressure. It is appropriate to ask directly: "What is the gonadotoxic risk of the planned treatment, and can I be referred for urgent fertility preservation?"
Q: What if I cannot have egg freezing because treatment must start immediately?
A: Speak to the fertility team about whether a random-start protocol is possible (starting stimulation immediately rather than waiting for the cycle), or whether ovarian tissue freezing is appropriate for your situation. For male patients, sperm banking can be completed in a single day.
Q: Will using my frozen eggs after cancer treatment work?
A: Outcomes depend on the age at which the eggs were frozen and egg quality at the time of collection. Eggs frozen at younger ages have better developmental potential than those frozen later. HFEA data on IVF from frozen eggs (not cancer-specific) shows live birth rates per transfer cycle of approximately 20–30% for eggs frozen under 35. Eggs frozen before cancer treatment in young patients often have good expected outcomes.
Q: Does chemotherapy always cause permanent infertility?
A: Not always. The degree of damage depends on the agent, dose, and the patient's age and baseline ovarian reserve. Some patients recover ovarian function after chemotherapy and conceive naturally. Preserving fertility before treatment maintains options even if natural recovery occurs — preserved material can simply remain stored unused if natural fertility returns.
Q: Can I bank sperm even if my cancer is testicular?
A: Yes. For testicular cancer specifically, sperm banking before any treatment (chemotherapy or orchidectomy) is strongly recommended, as treatment affects both testes to varying degrees. Sperm quality at diagnosis may already be lower than average (testicular cancer is associated with reduced sperm quality), but banking as many samples as possible before treatment starts is still the right approach.
This article is for information only. If you are facing cancer treatment, discuss fertility preservation urgently with your oncology and fertility teams as soon as possible after diagnosis.