Preserving your fertility before cancer treatment

This isn’t the main focus of my work, and in most cases fertility preservation takes place in the country where the patient is being treated, in direct coordination with the oncology team. I’m raising this topic because I’m asked about it, and because the information often comes too late. If you’re reading this straight after a diagnosis, the one thing to remember is: book an oncofertility consultation now.

Why treatments affect fertility

Certain chemotherapy drugs, particularly alkylating agents (such as cyclophosphamide), destroy some of the ovarian follicles or impair sperm production. Radiotherapy to the pelvis or abdomen can damage the ovaries and the womb. The effect depends on the drug, the dose and age: the higher the ovarian reserve at the start, the more resilient it is.

The risk is explained by the oncology team; it ranges from low to very high. Even an ‘intermediate’ risk warrants discussion.

Options for women

• Oocyte freezing: ovarian stimulation followed by egg retrieval, as in IVF. Thanks to protocols that can be started at any point in the cycle (‘random start’), the process takes around two weeks. This is the most established option. See egg freezing.
• Embryo freezing: if the patient has a partner. The timeframe is the same, but the embryos belong to the couple, which may raise issues in the event of a separation.
• Ovarian tissue freezing: removal of a fragment of ovarian tissue via laparoscopy, without stimulation, which can be carried out within a few days. This is the only option before puberty or when treatment cannot be delayed. The tissue is transplanted at a later date; several hundred births have been reported worldwide.
• GnRH agonists during chemotherapy: these appear to reduce the risk of ovarian failure, particularly in breast cancer, but are not a substitute for freezing.

What about hormone-dependent cancers?

For breast cancer, letrozole is often added to the stimulation regimen, which limits the rise in oestrogen levels. Follow-up studies have not shown an increase in recurrence linked to stimulation for fertility preservation. The decision is always made in consultation with the oncologist.

Options for men

Sperm freezing is quick and straightforward: one or more collections, ideally before any chemotherapy. If there are no sperm in the ejaculate, sperm can be retrieved surgically from the testicles (see azoospermia and TESE). In prepubertal boys, testicular tissue freezing remains experimental.

The legal framework in Greece

Greek Law 3305/2005 authorises the cryopreservation of gametes and gonadal tissue for medical reasons, including in anticipation of treatment that threatens fertility. A patient living in Greece or receiving treatment there can therefore be treated promptly at a licensed clinic. For patients receiving treatment in another country, it is almost always preferable to carry out preservation locally: it is not reasonable to delay cancer treatment in order to travel.

However, Greece can play a role at a later stage: to use stored eggs or embryos (transfer between clinics is possible, subject to conditions), or for egg donation if preservation was not possible. The storage duration and transport of gametes are subject to specific rules.

After treatment

Oncologists often recommend waiting a certain period — which varies depending on the type of cancer, often two years for breast cancer — before attempting to conceive. An assessment of ovarian reserve following treatment helps to determine whether a spontaneous pregnancy remains possible. Many women retain their fertility; some have ovarian insufficiency and will use their frozen eggs or a donation.

What I’ve learnt from my experience

Patients who preserved their fertility before treatment did not always go on to use it. But none of them told me they regretted having done so. Those who did not have the opportunity, on the other hand, often mention it to me. If you’re close to someone who has just been diagnosed, this is a question you could ask on their behalf.

Frequently asked questions