Preserving Fertility With Cancer Treatment in Children

Thinking about your child’s future family can feel overwhelming during cancer care. It is okay to have questions. Learning about fertility now can help you talk with the oncology team and make choices that fit your child and your family.

What is fertility?

Fertility is the ability to get pregnant or to get a partner pregnant. Some cancer treatments can affect this ability for a short time or for the long term.

“Preserving fertility” means taking steps to protect or save eggs, sperm, or reproductive tissue so your child might have biological children in the future.

Why think about fertility before treatment?

Some treatments can cause fertility problems years later. Many fertility steps must happen before cancer treatment starts or early in care. Bringing this up now gives your family more options.

What are fertility problems?

For females: trouble getting pregnant or carrying a pregnancy.
For males: trouble getting a partner pregnant.

Which cancer treatments can affect fertility?

Chemotherapy – Medicines that kill cancer cells can also harm eggs or sperm. Risk depends on the drug and dose. Some medicines (for example, certain alkylating agents) carry higher risk.
Radiation therapy – High-dose X-rays can affect the ovaries, uterus, or testicles. Risk depends on the dose and the body part treated. Scatter radiation can also cause harm.
Surgery on the sex organs – Operations on the ovaries, uterus, or testicles can affect fertility if these organs are removed or damaged.

Not everyone will have fertility problems. Your child’s oncology team can explain the specific risks for your child’s treatment plan.

How can fertility be preserved?

Start by talking with the oncology team before treatment begins. In some cases, there may be safe treatment choices with lower fertility risk. Timing matters, so let the team know this is a priority for your family.

Fertility options depend on your child’s body, age, and whether they have gone through puberty. Some options are standard. Others are still being studied and may be offered only in research programs.

Options for children who have not gone through puberty

During radiation: Shielding the sex organs can reduce exposure. The care team places a protective shield over the area during treatment.
For girls: Freezing small pieces of ovarian tissue (ovarian tissue cryopreservation) can sometimes be done. This involves surgery to remove tissue that contains immature eggs. It is used in some centers and may still be part of research for younger children.
For boys: Freezing small pieces of testicular tissue (testicular tissue cryopreservation) is available only in research settings. This method is still being studied, and there are no confirmed live births from this tissue yet.

These surgeries use anesthesia and carry risks, so the team will weigh the benefits and timing with you.

Options for boys who have gone through puberty

Shielding during radiation to protect the testicles when possible.
Sperm banking (sperm cryopreservation): collecting a semen sample and freezing sperm before treatment. Many teens can provide a sample by masturbation in a private room.
Other ways to collect sperm if needed: the team may use medicines or procedures to help ejaculation, or a minor procedure to remove sperm from the testicle. Ask about timing, comfort, and risks.
Testicular tissue freezing: still being studied and usually available only through research.

Options for girls who have gone through puberty

Shielding during radiation to protect the ovaries and uterus when possible.
Moving the ovaries (oophoropexy): a surgery to move the ovaries out of the radiation field when pelvic radiation is needed.
Egg freezing (oocyte cryopreservation): medicines help the ovaries grow multiple eggs; a minor procedure then removes the eggs for freezing. This process usually takes about 2 to 3 weeks and may require a short delay before treatment. Ask the team if a faster schedule is possible.
Ovarian tissue freezing: removing and freezing small pieces of the ovary. This may be considered when there is not time for egg freezing or in younger teens. Discuss benefits, risks, and future options for using the tissue.

Some medicines are sometimes used to try to protect ovaries during chemotherapy, but their benefits for young patients are uncertain. Ask your child’s oncology team about the latest evidence.

Timing and planning

Some options must happen before chemotherapy or radiation starts.
Emergency pathways may speed up scheduling when cancer treatment needs to start soon.
Your child’s safety always comes first. If a delay is not safe, the team will explain other options.

How do we decide what is right for our child?

Your child’s cancer and treatment plan – risk level and timing.
Age and puberty status – what is possible now.
Benefits and downsides – success chances, surgical risks, and recovery.
Values and future goals – what matters most to your child and family.
Costs and access – collection, freezing, and storage fees; what insurance may cover.

Ask for a referral to a fertility specialist (often called reproductive endocrinology or oncofertility). A social worker or navigator can help with logistics and financial resources.

Questions to ask the oncology team

How likely is this treatment to affect my child’s fertility?
Which preservation options fit my child’s age and body?
How much time do we have before treatment starts?
What are the risks, benefits, and chances of success?
What will it cost now and later for storage?
Is this option standard or part of a research study at your center or nearby?

Life after treatment: follow-up and testing

Ask about long-term follow-up for fertility and hormone health.
For boys and young men, semen testing can check sperm after puberty or later.
For girls and young women, blood tests and ultrasounds can look at ovarian reserve and menstrual health.
Puberty and growth should be monitored. Tell the team about changes in periods, erections, or sexual development.

Emotional support

These decisions can feel rushed and emotional. It is normal to feel worried or unsure. You do not have to decide alone. Ask for support from a counselor, child life specialist, social worker, or faith leader. If your child is old enough, include them in age-appropriate ways.

Common myths

Myth: Talking about fertility means we are not focused on curing the cancer. Fact: You can do both. Planning early may protect future choices.
Myth: If treatment affects fertility, there is nothing we can do later. Fact: Many people build families in different ways, including using banked sperm or eggs, donor options, or adoption.

Helpful resources and references

Alliance for Fertility Preservation

Last reviewed: 2025-12-04