Fertility preservation before childhood cancer treatment — what every parent needs to ask

Not always — but the risk depends on the type of cancer treatment your child receives, the doses used, and your child's sex and age. Certain chemotherapy agents and radiation directed at or near the reproductive organs carry a higher chance of affecting future fertility. Treatments aimed at other parts of the body carry much lower risk. Surgery that removes reproductive organs is the most direct cause of infertility. Your child's oncology team can give you a clearer picture of the risk level for your child's specific treatment plan once staging and the full treatment schedule are confirmed. It is important to ask this question before treatment begins, because most fertility preservation options must be arranged before the first dose is given.

Yes, there are options being used in clinical practice for young children, though some remain in the research or early clinical phase. Ovarian tissue cryopreservation — removing and freezing a small piece of ovarian tissue before treatment — has been performed in girls including those under ten years old. Testicular tissue cryopreservation follows a similar approach for pre-pubertal boys. These procedures are done under a short general anaesthetic. Importantly, the delay to treatment is usually very small — fertility preservation is designed to happen within the window between diagnosis and the start of treatment. Ask your oncology team to refer you to a reproductive specialist as early as possible after diagnosis.

Sperm banking — also called sperm cryopreservation — means collecting and freezing a semen sample before cancer treatment begins. It is available for teenage boys who have already reached puberty and can produce a semen sample. The sample is collected, assessed in a laboratory, and frozen for storage for many years. The procedure does not involve surgery and does not delay treatment. The stored sperm can be used in the future for assisted reproduction if the young man finds that his fertility has been affected by treatment. It is one of the most established and widely accessible fertility preservation options, and the sooner it is discussed after diagnosis, the more time there is to arrange it before treatment starts.

Ovarian tissue cryopreservation (OTC) involves removing a small piece of the outer layer of one ovary under general anaesthesia, then freezing and storing the tissue. This option is used for girls who cannot wait for egg freezing, or who are pre-pubertal and do not yet produce mature eggs. When the young woman is ready to start a family in the future, the tissue can be thawed and re-implanted near the remaining ovary. The re-implanted tissue has the potential to restore hormonal function and natural fertility in some cases. Clinical teams assess each girl individually to decide whether the procedure is appropriate and whether there is any risk of cancer cells being present in the tissue before re-implantation.

In most cases, fertility preservation can be arranged within a few days to about two weeks — a window that fits within the time usually needed to complete staging investigations and finalise the treatment plan. The referral from the oncology team to a fertility specialist can happen on the same day as the diagnosis conversation. The procedures themselves — sperm banking, egg or embryo freezing, or ovarian tissue removal — are generally short and do not require lengthy hospital admissions. The key is to raise the subject as soon as possible. At CION Cancer Clinics, our coordinated care approach means the oncology team proactively discusses fertility risk with families and helps connect them with reproductive specialists without adding delay to the start of treatment.

No. The goal is to have the conversation and, where appropriate, complete a preservation procedure within the window before the first treatment session — not to delay treatment. Most fertility preservation procedures take one to three days for sperm banking, and up to five to seven days for surgical tissue removal, which is well within the planning window that already exists between diagnosis and the start of treatment. The oncology team and fertility specialist work together to make sure nothing slows down treatment. If the cancer requires an urgent start to treatment, the team will advise on whether there is still a safe window for any procedure, or whether other options apply.