# Fertility discussion and preservation before cancer treatment

Source: https://onco.cc/protocols/fertility-preservation-before-cancer-treatment/  
OnCo record `fertility-preservation-before-cancer-treatment` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some cancer treatments can make it harder or impossible to have children later. Before treatment, your team should discuss this and, if you want, refer you quickly to a fertility specialist. Freezing sperm, eggs, embryos or ovarian tissue are the established options; an injection to rest the ovaries during chemotherapy can be added for some women with breast cancer but does not replace freezing.

## Summary

Every person whose treatment may affect fertility should be told about the risk and the options before treatment, at the earliest opportunity where treatment is urgent (NICE NG257, 2026; ASCO 2025), and those who are interested or unsure referred promptly to a reproductive specialist (ASCO). NICE offers sperm cryopreservation, and oocyte or embryo cryopreservation, to people of reproductive age facing treatment likely to make them infertile, and ovarian tissue cryopreservation when oocyte or embryo storage is not feasible, for example before puberty; NHS-funded preservation is not bound by the usual eligibility criteria such as the lower age limit, and storage is reviewed at least every 5 years.

ESHRE (2020) recommends the GnRH antagonist protocol for ovarian stimulation for its speed and safety (strong), random-start stimulation as an option in urgent cycles (weak), and concurrent letrozole in oestrogen-sensitive cancers (good practice point). GnRH agonists during chemotherapy should be offered as an option for ovarian function protection in premenopausal women with breast cancer (ESHRE, strong), but not instead of cryopreservation (ESHRE; ASCO 2025: an adjunct only, in breast cancer). ASCO adds that testicular tissue freezing in prepubertal boys is experimental, that ovarian tissue cryopreservation is the only established method before puberty in girls, and that sperm collected soon after starting treatment may carry more genetic damage.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: oncofertility referral; egg freezing before chemotherapy; sperm banking before cancer treatment; embryo freezing before cancer treatment; ovarian tissue freezing; GnRH agonist ovarian protection during chemotherapy; goserelin to protect the ovaries
- Tags: protocol; fertility; survivorship; aya

## Connected records

- drugs: [Goserelin / leuprolide (ovarian function suppression)](https://onco.cc/drugs/goserelin/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/)
- technologies: [Fertility in boys and young men treated for cancer, including testicular tissue banking](https://onco.cc/technologies/rejuv-paed-fertility-male/), [Fertility in girls and young women treated for cancer, including ovarian tissue freezing](https://onco.cc/technologies/rejuv-paed-fertility-female/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Who gets told about fertility before treatment, and who does not](https://onco.cc/technologies/rejuv-access-fertility-preservation/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Fertility before lymphoma treatment: what to ask for, and when](https://onco.cc/terms/lymphoma-tx-fertility-preservation/)
- ideas: [Default fertility preservation referral for every patient under 40 before treatment](https://onco.cc/ideas/idea-acc-default-fertility-preservation-referral/)
- protocols: [Sexual health after cancer: assessment and interventions for women and men](https://onco.cc/protocols/sexual-health-assessment-and-interventions/)

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