Fertility preservation

Preserving fertility means collecting and storing sperm, eggs, embryos or tissue from the testicle or ovary. This may be an option if there is a risk that cancer treatment might make you infertile (unable to start a pregnancy).

Cancer and fertility preservation

If there is a risk your cancer treatment might affect your fertility, your cancer doctor or nurse should talk to you about fertility preservation. Fertility means your ability to start a pregnancy.

Preserving fertility means collecting and storing sperm, eggs, embryos or tissue from the testicle or ovary. Your right to fertility preservation is the same:

  • whether or not you are in a relationship
  • whatever your sexual orientation
  • whatever your gender identity.

At the fertility clinic

If you think you may want to preserve your fertility, you will be referred to a fertility clinic. The doctor or nurse at the fertility clinic will explain:

  • what fertility preservation involves
  • the possible risks and benefits
  • your options for starting a pregnancy in the future.

If you decide to preserve your fertility, you will have a blood test to check for infections such as HIV and hepatitis B and C. The results will not affect whether you can have fertility preservation. But it helps the clinic store your cells or tissue safely.

You will be asked to sign consent forms that explain how your sperm, eggs, embryos or tissue can be used in the future. Staff at the fertility clinic will talk to you about this and explain your options.

We have a table comparing the different fertility preservation methods.

Cost of fertility preservation

In some situations and some areas of the UK, the NHS may provide fertility preservation and storage for free. But this can vary and you may have to pay for it yourself. Staff at the fertility clinic will tell you what is available for you. Even if the NHS pays for storage, you may have to pay for any fertility treatment you need in the future.

Your doctor or nurse will give you information about costs in your area. You can also get information about costs from the fertility clinic or on their website.

Storage is usually for at least 10 years. This can be extended every 10 years up to 55 years in total.

More information about fertility clinics

You can find information about NHS and private fertility clinics on the Human Fertilisation & Embryology Authority (HFEA) website. HFEA also has information about access to treatment for same-sex couples and for trans and non-binary people.

If you are taking gender-affirming hormones

Gender-affirming hormones are also called:

  • cross-sex hormones
  • feminising hormones
  • masculinising hormones.

These treatments affect your body’s ability to produce sperm or eggs.

You usually need to stop taking gender-affirming hormones for at least 3 months before fertility preservation. This gives you the best chance of being able to produce sperm or eggs that can be collected.

Unfortunately, there is not usually time to do this before cancer treatment. But if you have not already stored sperm or eggs, you may be able to after cancer treatment.

Storing sperm

Collecting and storing sperm is sometimes called sperm banking. It is a safe and simple process that has been used for many years.

You can store sperm if you have reached puberty and your body is producing sperm. Your sperm will be frozen and stored in liquid nitrogen. This is called cryopreservation.

If you decide to store your sperm, your doctor will likely advise you to do it before cancer treatment starts. Treatment can affect the quality and number of sperm your body produces. Your cancer doctor or specialist nurse can talk to you about this.

Collecting sperm

Sperm is usually collected from samples that you give by masturbating. There will be a private room in the fertility clinic where you can give a sample.

People often feel embarrassed or worried about giving sperm samples. Having to produce a sample in this situation can be stressful. If you are worried or have questions, talk to the staff at the clinic. They may be able to give you advice or information that helps you prepare for giving samples.

It may be possible to masturbate at home and then take your sample to the clinic. You need to keep the sample warm and take it to the clinic within 45 minutes of producing it. The clinic can give you more information about this.

If you can only give 1 sample before cancer treatment starts, it may be enough. But you may be asked to provide 2 or 3 samples over a week to get good-quality samples. Your fertility doctor or nurse will tell you how many samples you need to give. They usually advise you:

  • to stop having sex or masturbating for 1 to 2 days before giving each sample – this allows more sperm to be collected
  • not to stop having sex or masturbating for more than 7 days before each sample – this helps you produce better-quality sperm.

Surgical sperm extraction

If you cannot produce a sample by masturbation, a specialist doctor may be able to collect sperm from the testicle. This is called surgical sperm extraction or retrieval. It can be done before or sometimes after cancer treatment.

For some type of cancer, you may be able to have sperm extraction during surgery to treat the cancer. Your doctor will tell you if this is an option for you.

Sperm extraction is done in 1 of the following ways:

  • Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA)

    The doctor passes a fine needle into the testicle or the epididymis to collect sperm. The epididymis is a tube on the side of each testicle. It stores and carries sperm.

  • Testicular sperm extraction (TESE)

    The doctor takes tiny bits of tissue from the testicle.

  • Microscope-assisted testicular sperm extraction (MicroTESE) or microsurgical epididymal sperm aspiration (MESA)

    the doctor uses a microscope during the extraction. This helps them select fluid and tissue from the testicle or the epididymis that is most likely to contain sperm.

Before the extraction, you usually have a local anaesthetic and sedation. Sometimes you have a general anaesthetic.

The collected fluid or tissue is looked at under a microscope in a laboratory. Any sperm are removed, frozen and stored for future use with fertility treatments such as ICSI.

Urinary sperm retrieval

If you have retrograde ejaculation, sperm and semen go into the bladder when you orgasm.

It may be possible to collect sperm from your urine (pee). You will be given a drink that makes your urine less harmful to your sperm. You pass urine and then masturbate. After you orgasm (come), you pass urine again. The sperm are quickly collected from your urine. They are then stored.

Storing testicular tissue

Your body starts making sperm during puberty. If you need cancer treatment before puberty, you cannot store sperm. But it may be possible to collect and store small samples of tissue from the testicles. To collect the tissue, you have keyhole surgery before cancer treatment starts.

This is called testicular tissue cryopreservation. It is not a standard treatment and is only available at a few clinics in the UK. In the future, there may be ways to use the stored tissue to produce sperm. But research into this is still at an early stage. Testicular tissue has not yet been used to start any pregnancies. Doctors do not fully know the risks involved.

Storing eggs

You can store eggs if you have reached puberty and your body is producing eggs. This is a common and effective way of preserving fertility.

You usually have hormone injections to help you release more eggs. This is called ovarian stimulation. The eggs are collected and then frozen and stored in liquid nitrogen. This is called cryopreservation.

Ovarian stimulation

For 8 to 14 days before the eggs are collected, you have injections of hormones called gonadotrophins. These are daily injections you have into the skin. The hormones make the ovaries produce more mature eggs than usual. Collecting as many eggs as possible increases your chance of starting a pregnancy in the future.

Ovarian stimulation is not suitable for everyone. For example, there may not be time if you need to start cancer treatment straight away.

Full ovarian stimulation may not be an option if you have an oestrogen-sensitive cancer. This means a cancer that is encouraged to grow by the hormone oestrogen. This includes some types of breast cancer, ovarian cancer and womb (endometrial) cancer. The gonadotrophin injections increase your level of oestrogen and may be harmful.

If you have 1 of these cancers, your cancer doctor and fertility specialist can give you advice. It may be possible to collect eggs in 1 of the following ways:

  • Without ovarian stimulation – your doctor may be able to collect 1 or 2 eggs in this way. But collecting fewer eggs reduces your chance of starting a pregnancy in the future.
  • With 1 injection of ovarian stimulation.
  • With a hormonal therapy tablet called letrozole during ovarian stimulation – letrozole helps protect you from the effects of oestrogen on cancer cells.

Your doctor will explain any risks of ovarian stimulation and give you information about your options.

Monitoring ovarian stimulation

During ovarian stimulation, you will have tests at the fertility clinic. These can show when the eggs might be ready to collect.

You will have:

  • blood tests – to check hormone levels
  • ultrasound scans.

Ultrasound uses sound waves to check how the follicles containing the eggs are developing in the ovaries. The ultrasound probe goes inside the vagina. This is not usually painful. The probe is about as wide as a large tampon.

If you cannot or do not want to have the scan through the vagina, the probe can be placed against the tummy (abdomen).

Collecting the eggs

A doctor collects the eggs when they are mature. This is usually about 14 days after the start of ovarian stimulation. The doctor uses a vaginal ultrasound probe to guide a needle through the top of the vagina and into the ovaries. They collect the eggs through the needle. This is done under sedation to make the procedure more comfortable.

The collection takes about 15 to 20 minutes. You can usually go home after a few hours.


Egg collection
Image: The illustration shows how eggs are collected. It shows the pelvic area from the front and the position of the vagina, ovaries and fallopian tubes inside the body. Inside each ovary are 6 small dots which are the follicles. There is a long, thin ultrasound probe which has been inserted between the legs, into the vagina. The probe goes up to the top left-hand side of the vagina. A fine needle is shown at the top of the probe. The needle goes through the wall of the vagina and up into a follicle in the left-hand ovary.

Freezing the eggs

After the eggs have been collected, they can be frozen and stored. There are different ways to do this. The most successful way to freeze eggs is a method called vitrification. This involves freezing the eggs very quickly. Vitrification is not available at every fertility clinic. Talk to your fertility doctor about your options.

Storing embryos

This is another common and effective way of preserving fertility. You have the same process for collecting eggs. After the eggs have been collected, they are mixed with sperm to encourage fertilisation. This is called in vitro fertilisation (IVF). The fertilised eggs develop into embryos. The embryos are then frozen and stored for later use.

Embryos can be slowly frozen or quickly frozen by vitrification. Both methods are safe. Many babies have been born using frozen embryos.

Consent and using embryos

If a partner provided sperm to create the embryos, they have equal rights in deciding what happens to the embryos. If they withdraw their consent for you to use the embryos in the future, you will not be able to use them.

If a partner did not provide sperm or eggs for the embryos, but you signed the consent forms together as a couple, they may still have some rights. For example, a lesbian couple may give consent as a couple to create embryos. Both partners may have rights to decide what happens to the embryos.

Even if you have a partner, you can still choose to freeze your unfertilised eggs. You do not have to use the eggs to create embryos straight away. If you and your partner split up, your partner has no rights to decide how the eggs are used in the future.

Storing tissue from an ovary

For some people, it may be possible to collect and store tissue from an ovary. This is called ovarian cryopreservation. It is not a standard treatment and is only available at a few clinics in the UK. Even small pieces of ovarian tissue can contain thousands of immature eggs. After cancer treatment, the tissue can be put back into the body during a small operation. This may make it possible to get pregnant or start a pregnancy with fertility treatment.

To collect the ovarian tissue, you have keyhole surgery before cancer treatment starts. The surgeon removes pieces or all of 1 ovary. The collected tissue is frozen and stored.

Ovarian cryopreservation may be an option if you:

  • have to start cancer treatment quickly
  • cannot have ovarian stimulation drugs
  • have not reached puberty (started having periods).

It may not be suitable if there is any risk of there being cancer cells in the ovary.

Ovarian cryopreservation is a newer method. It is not widely available in the UK. Only a few babies in the world have been born using stored ovarian tissue.

About our information

  • References

    Below is a sample of the sources used in our fertility and cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 2020; 31, 12, 1664-1678.

    National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. [Internet]. 2017, Available from www.nice.org.uk/guidance/CG156 [accessed November 2022].

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

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Date reviewed

Reviewed: 01 April 2023
Next review: 01 April 2026
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.