Oncofertility sits where oncology meets reproductive medicine. Chemotherapy, radiation and some cancer surgeries can reduce or end fertility, and the window to act is usually before treatment begins. It covers the options that keep the choice open: freezing eggs, sperm, embryos or ovarian tissue ahead of time.
With survival rates rising, fertility preservation is now discussed as part of routine cancer care rather than as an afterthought. Cost varies widely with which option suits you, and provincial coverage matters a great deal: OHIP funds most fertility preservation for oncology patients in Ontario, while other provinces differ, and several clinics subsidise cancer patients directly. Ask your oncologist for a fertility referral as early as you can, because timing is usually the real constraint rather than money. Where fertility is a concern outside a cancer diagnosis, female fertility preservation uses the same techniques on a planned timeline.
Oncofertility is a subfield of oncology and reproductive research that aims to maximize the reproductive potential of cancer patients and survivors. Different cancer treatments and surgeries can have an impact on an individual’s reproductive cells and anatomy, making it difficult to have children. Oncofertility allows for fertility preservation options, allowing cancer patients to grow their family in the future.
Cancer diagnosis and treatment can make childbirth more difficult or even cause uncertainty about having children in the future. Cancer treatments can also harm both men’s and women’s reproductive systems, impairing fertility for a variety of reasons, including:
Radiation and chemotherapy – damage to a woman’s ovaries and uterus can impact her ability to conceive.
Spermatogenesis – cancer treatments can affect the process of sperm production in men.
Surgical treatments disrupting hormone levels needed for adequate reproductive function. Changes in hormonal levels can result in early menopause, damaged nerves, or dysfunctional sex organs.
Surgical procedures removing reproductive organs required for fertility.
Removal of tumors or tissue in or around reproductive organs.
Surgical procedures performed on the abdominal, brain, and nervous system.
If you are a cancer patient who is also an aspiring parent, it is critical to discuss your prognosis and fertility goals with your preferred doctor(s) as early as possible. The preferred health care team may be able to plan a treatment that increases the chances of remaining fertile after cancer treatment or take proactive steps prior to treatment in preparation for fertility issues. If fertility is important to you, learning about the risks and available options before cancer treatment or surgery may be beneficial.
There are several ways to have a child after cancer treatment, including fertility treatment options such as:
Cryopreservation – Cryopreservation, done in conjunction with assisted reproductive technologies (ARTs), involves freezing sperm, eggs, and embryos for future use. This method is a safe and effective way for individuals to preserve their ability to have children after cancer treatments.
Sperm Cryopreservation – Sperm cryopreservation is a non-invasive, effective option for men who want to preserve their fertility. Men who have cryopreserved sperm and used intracytoplasmic sperm injection (ICSI) have a greater possibility of fathering a child in the future.
Embryo Cryopreservation – Embryos created through in vitro fertilization (IVF) are frozen and stored for later use. This method should be used prior to cancer treatment, and the sperm used to create the embryo must come from a willing partner or donor. The egg that was retrieved, fertilized, and cryoprotected will be thawed and used when the woman has completed cancer treatment and is ready to carry a baby.
Egg (Oocyte) Cryopreservation – Female patients who do not have a partner, do not want to use donor sperm, or are ethically or religiously opposed to embryo cryopreservation may benefit from egg freezing. Although eggs are susceptible to the physical and chemical damage caused by cryopreservation, as research advances, it is becoming a more viable option.
Every cancer patient and survivor has a unique history, circumstance, and fertility goal, so each oncofertility treatment plan will be tailored to reflect the individual’s specific needs. Oncofertility costs are determined by factors such as treatment recommendation, geographic location, physician and clinic experience/technique, and medical factors such as appointments, medications/fertility drugs, storage time of cryopreserved specimens, and assisted reproduction technology (if applicable).
Usually only by a short period, and often not at all. Sperm banking takes a day or two. Egg or embryo freezing needs roughly ten to fourteen days of ovarian stimulation, and random-start protocols mean that can now begin at almost any point in your cycle rather than waiting for the next one. Your oncologist and fertility specialist decide together whether that window is safe for your particular cancer - for most people it is.
It depends where you live. Ontario funds most fertility preservation for oncology patients through OHIP, including egg, embryo and sperm freezing. Other provinces vary, and it is not fully covered in Manitoba or New Brunswick. Several clinics also offer oncology-specific subsidies, and the charity Fertile Future runs a programme for Canadian cancer patients. Ask the clinic what applies to you before assuming you will pay the full amount.
As early as possible - ideally at the point of diagnosis, before treatment is scheduled. Timing is the real constraint in oncofertility far more often than cost. Ask your oncologist for a fertility referral at your first appointment, even if you are not sure you want children; deciding later is possible, but preserving later often is not.
Sometimes, but the options narrow. Chemotherapy and radiation affect eggs and sperm during treatment, so anything collected afterwards may be of lower quality, and some regimens cause permanent loss. Testicular sperm extraction and ovarian tissue techniques are occasionally possible after treatment. It is always worth asking rather than assuming the door has closed.
They stay in storage until you are cleared by your oncologist to try for a pregnancy, which is commonly two to five years after treatment. Storage is charged annually, typically a few hundred dollars. When you are ready, frozen eggs or embryos are used through in vitro fertilization (IVF), and frozen sperm through IVF or insemination. Your clinic will ask you periodically to confirm what you want done with anything in storage.
