# Fertility protection before pelvic radiotherapy: ovarian transposition, egg, embryo and sperm freezing

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

## TL;DR

Radiotherapy to the pelvis can stop the ovaries working and end fertility, and can damage sperm production. Before treatment starts, your team should talk with you about fertility and refer you quickly if you want to protect it: sperm, eggs or embryos can be frozen, and for some women a surgeon can move the ovaries up out of the radiation field.

## Summary

Ovaries are very sensitive to radiation: in women under 40, under 2 Gy is estimated to destroy half the oocytes and 14 Gy may cause complete ovarian failure (review of Wallace et al.), far below pelvic doses for cervical, rectal or anal cancer. NICE NG257 (March 2026) says to discuss fertility preservation with everyone preparing for treatment likely to impair fertility, at the earliest opportunity if treatment is urgent; to offer sperm cryopreservation, and oocyte or embryo cryopreservation, to those of reproductive age; to consider ovarian tissue cryopreservation when those are not feasible; and not to apply the usual NHS fertility eligibility criteria. ASCO (2025) lists ovarian transposition among established methods for females, with embryo, oocyte and ovarian tissue cryopreservation.

ESHRE (2020) says women having pelvic radiotherapy without chemotherapy may be offered ovarian transposition to prevent premature ovarian insufficiency (WEAK, low certainty), that women with reduced ovarian reserve or at risk of ovarian metastases are not candidates (good practice point), and that transposition can be done at the same time as ovarian tissue cryopreservation. A 2026 review: transposition is for premenopausal women, generally 40 or younger, whose ovaries need not be removed; ovaries are moved at least 4 cm from the field or 1.5 cm above the iliac crest and marked with clips; reported success ranges from 15% to 100%, about 50% to 65% in cervical cancer after external beam radiotherapy, lower with chemotherapy; ovarian metastasis is rare (0.36% in cervical cancer). A 2022 meta-analysis of 1,160 women with cervical cancer found preserved ovarian function in 61% after external beam radiotherapy. Pregnancies after transposition and pelvic radiotherapy are few; a gestational carrier may be an option when the uterus has been affected by radiation (review).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ovarian transposition; oophoropexy; ovariopexy; fertility preservation before radiotherapy; sperm banking before radiotherapy; egg freezing before radiotherapy; ovarian tissue cryopreservation; oncofertility pelvic radiotherapy; premature ovarian insufficiency after radiotherapy

## Connected records

- protocols: [Consent for radiotherapy: who takes it, when, and what it must cover](https://onco.cc/protocols/radiotherapy-consent/), [Pregnancy and breastfeeding checks before radiotherapy](https://onco.cc/protocols/radiotherapy-pregnancy-and-breastfeeding-enquiry/)
- cancers: [Anal cancer (squamous cell carcinoma)](https://onco.cc/cancers/anal/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)

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