# Fertility preservation offered and funded by default before gonadotoxic treatment

Source: https://onco.cc/ideas/idea-moon-fertility-preservation-default/  
OnCo record `idea-moon-fertility-preservation-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Everyone of reproductive age about to have treatment that can cause infertility is offered egg, sperm or tissue freezing, paid for, before treatment starts.

## Summary

Guidelines recommend fertility counselling for all patients of reproductive age, but referral rates remain low and cost is a common barrier. The proposal is an opt-out pathway: automatic referral triggered by age and regimen in the prescribing system, guaranteed appointments within a week, and funding from the payer for preservation and storage. Outcomes include referral rate, preservation uptake and treatment delay.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Opt-out referral raises documented fertility counselling above 90% and preservation uptake severalfold without delaying treatment start by more than a few days.
- Rationale: Infertility is among the most regretted long-term effects and the intervention window is short; default pathways fix omission better than education.
- Proposed test: Stepped implementation across a network; primary endpoint documented counselling and preservation rates, secondary treatment delay and long-term regret.
- Maturity: being-tested-at-scale
- Actor: payer

## Sources

- Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015): https://doi.org/10.1200/JCO.2014.57.9334

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials](https://onco.cc/key-papers/paper-di-maio-j-clin-oncol/)
- technologies: [Fertility in girls and young women treated for cancer, including ovarian tissue freezing](https://onco.cc/technologies/rejuv-paed-fertility-female/), [Ovarian function after chemotherapy: who recovers, and when](https://onco.cc/technologies/ovarian-function-after-chemotherapy/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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