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Before your treatment starts

Fertility and Family Planning — Before Treatment Starts

Fertility preservation must happen before chemotherapy, radiation or surgery — not after. This is one of the most commonly skipped conversations in the rush to start treatment, and reversing it later is not always possible.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • Time-critical — Once chemotherapy or radiation begins, the window to preserve fertility may close permanently.
  • Options exist for most people — Sperm banking, egg freezing, and embryo freezing are established options, depending on your situation.
  • It may not delay your treatment — Sperm banking takes only a few days. Egg and embryo freezing takes longer, and many oncologists can accommodate that.
  • You have to ask — Most oncology teams will not raise this unless you do. You have the right to this conversation before treatment starts.
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Yes, this is time-critical. Fertility preservation must happen before chemotherapy, radiation or surgery begins — not after. Sperm banking can be done within a few days. Egg and embryo freezing takes several weeks and requires hormone injections. ASCO and NCCN both recommend that every patient of reproductive age is offered a referral to a fertility specialist before treatment starts.

How do you arrange fertility preservation before treatment?

  1. Raise it at your first planning appointment

    Tell your oncologist that you want to discuss fertility preservation before starting treatment. Do this as early as possible. If the conversation is being skipped over, ask directly: 'Should I see a fertility specialist before we begin?'

  2. Ask for a referral to a fertility specialist

    A fertility specialist — called a reproductive endocrinologist — will assess what options are available for you, explain the procedures, and tell you how long each takes. Your oncologist should be able to refer you, or you can ask for a recommendation.

  3. Understand which options apply to your situation

    The options depend on whether you have testes or ovaries, whether you have a partner, how much time is available before treatment must start, and your age. The fertility specialist will go through this with you. Do not rule yourself out before hearing what is possible in your specific case.

  4. Complete the preservation procedure

    Sperm banking involves providing a sample at a licensed fertility clinic and can usually be done within a few days. Egg and embryo freezing require daily hormone injections over several weeks to stimulate the ovaries, followed by an egg collection procedure. The fertility clinic will explain what to expect at each stage.

  5. Confirm completion to your oncology team and start treatment

    Once preservation is complete, inform your oncologist so treatment can begin. The fertility clinic and the oncology team should stay in contact throughout this process so the handover is smooth.

What should you ask your oncologist before treatment starts?

  • Ask whether the planned treatment — chemotherapy, radiation or surgery — carries a risk of affecting your fertility
  • Ask whether there is enough time before your treatment start date to complete a preservation procedure
  • Ask for a referral to a fertility specialist, or for a recommendation of where to go
  • Ask what the fertility clinic will need from your oncologist — your staging details, treatment plan, and planned start date
  • Ask whether the treatment approach can be adjusted to reduce fertility risk if preservation is not possible in time
  • Ask about the cost of preservation and ongoing storage, and whether any financial support is available

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Does fertility preservation delay cancer treatment?

For many people, the answer is no, or not significantly. Sperm banking can be completed within a few days and does not affect the treatment schedule.

Egg and embryo freezing takes longer, because it requires daily hormone injections to stimulate the ovaries before the eggs are collected. Your oncologist and fertility specialist together will assess whether your treatment start date can accommodate that process.

For some cancers that require very urgent treatment, waiting may not be possible. In those situations, the fertility team may be able to offer an abbreviated protocol, or discuss ovarian tissue freezing, which can sometimes be performed at the time of surgery.

If you are told there is no time, ask what that assessment is based on and whether any alternatives have been considered. Your oncologist and the fertility specialist can work through the question together.

What fertility preservation options exist?

For people with testes, sperm banking is the established option. It is simple, non-invasive, and does not require any hormone treatment beforehand.

For people with ovaries, the main options are egg freezing and embryo freezing. Egg freezing stores unfertilised eggs; embryo freezing fertilises the eggs with sperm before freezing, which requires a partner or a sperm donor. Both involve the same ovarian stimulation process.

Ovarian tissue freezing — recognised by ASCO as an option when ovarian stimulation is not possible — involves removing and storing a portion of ovarian tissue before treatment begins. The tissue may be reimplanted after treatment is finished. Ask your fertility specialist whether it applies to your situation.

Some oncologists also use hormone suppression during chemotherapy to reduce ovarian activity temporarily. The evidence on how reliably this protects future fertility is still developing; it is sometimes used alongside other preservation methods rather than instead of them.

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Common questions

Frequently asked questions

What if my oncologist says there is no time for fertility preservation?

If you are told there is no time, ask what the basis for that is. For most solid tumours and many blood cancers, a short delay for fertility preservation is generally accepted and does not affect treatment outcomes — this is reflected in ASCO and NCCN guidance. Where urgency is genuine, a fertility specialist may still be able to offer a faster option, such as an abbreviated stimulation protocol or ovarian tissue freezing if surgery is already planned. If you are not satisfied with the answer, you are entitled to a second opinion.

Can fertility be preserved after chemotherapy has already started?

In most cases, standard preservation approaches are no longer available once chemotherapy has begun. Egg and embryo freezing rely on healthy eggs that have not been exposed to chemotherapy drugs. Sperm banking may still be possible early in treatment if sperm production has not yet been affected, but this is time-sensitive and should be discussed urgently with a fertility specialist. The safest window is always before the first dose. If treatment has already started, ask your oncologist and a fertility specialist what, if anything, remains possible.

Does the type of cancer treatment affect the risk to fertility?

Yes, significantly. Some chemotherapy drugs carry a higher risk of permanently affecting fertility than others — alkylating agents are known to carry a higher risk than several other drug classes. Radiation to the pelvis carries a different risk from radiation to the head or chest. Surgery involving the reproductive organs has its own considerations. Your oncologist can tell you whether the planned treatment carries a high, intermediate, or low risk. Knowing this helps you and the fertility specialist decide how urgently to act and which options to prioritise.

What does fertility preservation cost in India?

Costs vary between fertility clinics and cities, and depend on which procedure is done and how long the material is stored. As a general guide, sperm banking is typically less expensive than egg or embryo freezing, which involves more procedures, medications, and laboratory work. Ask the fertility clinic for a complete breakdown — including annual storage fees — before committing, so there are no unexpected costs later. A small number of programmes in India offer subsidised fertility preservation for cancer patients; ask whether anything like that is available in your city.

Does cancer treatment always cause infertility?

Not always. The outcome varies widely by cancer type, treatment type, age, and individual factors that cannot be fully predicted in advance. Some people retain fertility after treatment and go on to conceive naturally. Others do not. The difficulty is that there is no reliable way to know in advance which will apply to you, which is why preservation before treatment — while options are still available — is the safer choice. Preserving fertility does not commit you to using it. Not preserving it may close that option permanently.

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