What is fertility preservation?
Fertility preservation refers to the process by which a person can save or protect their sperm. This will increase the likelihood that they can have biological children someday if they choose to. Download this fertility preservation handout.
What is fertility?
Fertility is the ability of a person to help make a baby with their sperm.
To make sperm, a person needs to have gone through puberty. Puberty starts when the testicles start making a hormone called testosterone. During puberty, the testicles will begin producing sperm. Sperm are released in ejaculate either from masturbation or having sex. To make a baby, a sperm and egg (from a person with ovaries) come together.
What are testes?
Testes are two small oval-shaped organs located in a pouch of skin called the scrotum. They produce sperm and hormones such as testosterone.
Some cancer treatments can damage sperm or stop the body from making sperm. This can decrease fertility. Therefore, it is important to think about ways to preserve fertility before starting treatment.
How cancer/bone marrow transplant affects fertility
Which therapies impact fertility?
The oncologist (cancer doctor) or transplant doctor will tell you if there are potential risks to fertility. In general, fertility may be affected by:
- chemotherapy: certain types of chemotherapy, such as alkylators (e.g., cyclophosphamide)
- surgery: removal of reproductive organs (e.g., testes)
- radiation therapy:
- close to or on the testes
- to the head (cranial radiation)
When should fertility preservation happen?
Fertility preservation is time-sensitive. It should be done before treatment starts if possible. There may be certain times when it cannot be done prior to starting treatment, and your health-care team will discuss fertility preservation options with you.
What if treatment has already started or finished?
There may still be options for fertility preservation after treatment starts depending on the type of treatment.
Is it still possible to have a family and children in the future if fertility preservation does not happen?
There are many ways to have a family and children in the future. If having biological children is not possible or wanted, there are other ways to have children such as:
- adoption
- fostering
- surrogacy
- sperm donation
Some people may also choose not to have children.
Options for preserving fertility
Sperm banking
Available for people with testes who have started puberty.
- Sperm is collected through masturbation and then frozen
Alternative methods
If sperm banking is not possible, your health-care team may discuss:
- Electroejaculation: a procedure that is done under general anesthesia that uses electrical energy to help produce a sperm sample that can then be frozen.
- Testicular sperm extraction (TESE): a surgical procedure to remove sperm from the testicle or to remove a small amount of testicular tissue (biopsy). Sperm can them be collected from the tissue and frozen.
- Testicular tissue cryopreservation (TTC): an experimental procedure which can only be done through a research study, where a surgical procedure is completed to remove a small amount of testicular tissue (testicular biopsy). The tissue is then frozen for future use.
If sperm banking, your health-care team will provide you with instructions on transporting the sperm sample.
Typically, any surgical procedures are done as a day procedure at (no need to stay overnight in the hospital). Some patients may need to be admitted the night before the procedure. Your health-care team will let you know if this is required. Your health-care team will give you personalized guidance for care after the procedure.
Risks associated with fertility preservation
Potential risks with sperm banking
- No procedural risks
- May require multiple attempts or the sample may not have enough sperm
Potential risks with alternative methods
- Risks associated with anesthesia
- Pain at surgical site (if applicable)
- Incision redness/irritation (if applicable)
- Bleeding
- Infection
- Rare injury to nearby organs
At SickKids
A member of your health-care team will start the conversation about fertility preservation with you. You will be referred to the Mount Sinai Fertility Team for coordination.
If sperm banking is chosen:
- For outpatients: An appointment will be made at Mount Sinai Fertility to collect the sperm sample.
- For inpatients: The sample can be collected in your hospital room and delivered to Mount Sinai Fertility.
For collection details for the patient, information about dropping off the sample and where to drop it off, see Sperm banking patient and family instructions.pdf.
Frequently asked questions
Does fertility preservation cost money?
Sperm banking and the storage of sperm for one sample are covered at SickKids for patients under 18 years of age who have been diagnosed with cancer or are undergoing bone marrow transplantation (BMT). Ask your health-care team for more information.
Do young people need permission from a parent/guardian to talk about fertility preservation or to go through the procedure?
Patients are encouraged to talk to their parents or guardians about fertility preservation. However, the choice to meet with a fertility specialist or to have fertility preservation is up to the patient. To have fertility preservation, patients need to understand the benefits, risks and impact in order to give consent.
What do most patients/families choose?
There is no right or wrong choice. Each situation is different, and your health-care team will support your choice.