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.

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.

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.

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.

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.

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.

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:

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.

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.

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.

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.

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).

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.

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.

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.