Oncofertility: Preserving Fertility Before Cancer Treatment
couple image
A cancer diagnosis at reproductive age is devastating on its own. What makes it harder — and what is still not consistently discussed with young patients in India — is that chemotherapy, radiation, and surgical cancer treatment can permanently destroy fertility. Ovarian function can fail. The uterus can be scarred. Future pregnancy may become impossible.
This does not have to be the outcome. Reproductive medicine has developed reliable techniques to preserve fertility before cancer treatment begins — and they work best when the conversation happens before treatment starts, not after.
Dr. Shachi Singh, consultant gynaecologist and fertility specialist at Prakash Hospital, Sector 33, Noida, explains.
How Cancer Treatment Damages Fertility
Chemotherapy: Many chemotherapy agents — particularly alkylating agents (cyclophosphamide, busulfan, chlorambucil) used for breast cancer, leukaemia, and lymphoma — directly damage ovarian follicles. The extent of damage depends on the agent, the cumulative dose, and the woman's age (older women lose more function because they have fewer follicles to start with). Damage can range from temporary amenorrhoea (periods return after treatment) to premature ovarian insufficiency — permanent loss of ovarian function and infertility.
Pelvic radiation: Direct pelvic or abdominal radiation damages the ovaries proportional to the dose and field. A dose of 5 to 10 Gy to the ovaries typically causes permanent ovarian failure. Uterine radiation damages the endometrium and myometrium — causing fibrosis and reduced uterine capacity to support pregnancy.
Surgery: Bilateral oophorectomy (removal of both ovaries) causes immediate surgical menopause and permanent infertility. Hysterectomy removes the uterus. Radical trachelectomy (fertility-sparing cervical cancer surgery) preserves the uterus but requires specialist technique.
When to Have the Fertility Discussion
The fertility preservation discussion should happen before treatment starts — ideally within the first week of diagnosis. Most cancer treatment can be delayed by 2 to 6 weeks for fertility preservation without affecting oncological outcomes. Oncologists and reproductive specialists need to communicate so that the cancer treatment timeline accommodates a preservation attempt where this is safe.
The oncofertility discussion should include every woman of reproductive age who:
- Wants future children
- Is about to receive gonadotoxic chemotherapy
- Is about to receive pelvic radiation
- Is about to undergo surgery affecting the ovaries or uterus
Fertility Preservation Options
Egg Freezing (Mature Oocyte Cryopreservation)
The most widely available and effective option for women who do not have a partner or do not wish to create embryos.
Process: 10 to 14 days of ovarian stimulation injections, followed by egg retrieval under sedation. Retrieved eggs are vitrified (rapid-freeze cryopreservation) and stored until the woman is ready to use them.
Success rates: Each egg has a 5 to 10% chance of resulting in a live birth — so a batch of 10 to 15 mature eggs gives a reasonable cumulative pregnancy chance. Younger women (under 35) produce more eggs per stimulation and have better egg quality.
Timing: Can be started at any point in the menstrual cycle using "random start" stimulation protocols — not waiting for the next period. This is critical when the treatment timeline is urgent.
Oestrogen sensitivity: In oestrogen-sensitive cancers (ER-positive breast cancer), standard stimulation protocols raise oestrogen significantly during stimulation. Modified protocols using letrozole alongside gonadotrophins produce a similar egg yield with lower peak oestrogen — the standard approach for breast cancer patients.
Embryo Freezing
The most established technique — mature eggs are fertilised with partner (or donor) sperm to create embryos, which are then vitrified.
Best for: Women with a partner who want the most proven preservation option. Embryo survival after thawing is higher than egg survival.
Consideration: Requires partner sperm and creates embryos jointly — with all the relational and legal implications that entails.
Ovarian Tissue Cryopreservation
The only option suitable for pre-pubertal girls and women who cannot delay treatment for stimulation. One ovary (or a portion) is surgically removed, cut into thin cortical strips containing follicles, and cryopreserved. After cancer treatment and remission, the strips are re-implanted — typically in the remaining ovary or on the pelvic peritoneum — and approximately 30 to 40% of women achieve natural restoration of ovarian function and pregnancy.
Important consideration: In cancers that may have ovarian involvement (certain leukaemias, borderline ovarian tumours), reimplantation carries a theoretical risk of reintroducing cancer cells. This requires oncologist and specialist input.
GnRH Agonist Suppression During Chemotherapy
GnRH agonists (monthly injections) are sometimes given during chemotherapy to suppress ovarian activity — the theory being that "sleeping" follicles are less vulnerable to chemotherapy damage. The evidence is mixed. GnRH agonist suppression should not be used as a substitute for proven fertility preservation techniques but may offer some additional protection alongside them.
After Cancer Treatment: Trying to Conceive
For women who preserved fertility before treatment, the process of using stored eggs or embryos follows standard IVF/FET (frozen embryo transfer) protocols — coordinated after oncological clearance.
For women who did not preserve fertility but whose ovarian function returns after treatment, natural conception attempts can usually begin after a waiting period recommended by the oncologist (typically 2 years for most breast cancers). This waiting period allows for the highest-risk recurrence period to pass before pregnancy.
Gynaecological and Fertility Care in Noida and Greater Noida
Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, provides fertility counselling for young women facing cancer treatment — and coordinates fertility preservation planning across Noida and Greater Noida.
To book an urgent consultation, call: +91 97023 46853
Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM
Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, UP 201301
This blog is for educational purposes only. Please consult Dr. Shachi Singh and your oncologist urgently if you are facing cancer treatment at reproductive age.
