As survivorship in children, adolescents and young adults treated for cancer improves, fertility preservation is a key priority. The Royal Women’s Hospital in Melbourne has a national tissue preservation service called In Time. They have developed the Fertility Preservation for Cancer Patients Clinical Reference Document to provide practical, evidence‑based guidance on fertility risk, preservation options and referral pathways.

Cancer treatment and fertility risks

Predicting individual risk is complex and depends on age, treatment type, dose, and therapy combination, the document notes.

Chemotherapy and radiotherapy can be highly damaging to ovaries and testes. In females, treatment can lead to premature ovarian insufficiency (POI), sometimes many years later. In males, treatments can cause low sperm count or permanent infertility. Surgical procedures can directly or indirectly affect fertility potential.

Gonadotrophic risk is stratified into three categories: minimally increased, significantly increased, or high-level increased risk—which guides fertility preservation decisions.

Discussing fertility with patients

Discuss fertility before treatment starts wherever possible, ideally not when patents get the cancer diagnosis. Conversations should be tailored to patient age, development, medical condition and cognitive capacity, the document advises.

Include parents/guardians in discussions with under-18s, while respecting adolescent needs (e.g. discuss sperm collection with a pubertal boy privately).

Clearly explain infertility risks, preservation options, and what could happen without intervention. Importantly, preservation procedures must not delay cancer treatment.

Fertility preservation options

The choice depends on pubertal status, timing, and treatment urgency, the document notes.

For males, options include:

• Semen cryopreservation – the most effective option for post-pubertal males
• Surgical sperm retrieval – if ejaculation isn’t possible
• Testicular tissue cryopreservation – the only option for prepubertal boys who cannot produce sperm before starting treatment, but still experimental

Options for females are:

• Oocyte or embryo cryopreservation – which is first line for post-pubertal females
• Ovarian tissue cryopreservation – the only option for prepubertal girls, it is also used when urgent treatment prevents ovarian stimulation
• GnRH agonists – may help protect ovarian reserve

Referring patients

All patients at moderate-to-high-risk of gonadotoxicity should be referred for fertility preservation, the document states.

Patients in Victoria can access public fertility care through The Royal Women’s Hospital, which also operates two national ovarian and testicular transport and cryopreservation initiatives (In Time and NOTTCS). Send referrals to RSU.FPS@thewomens.org.au.

More information

The Royal Women’s Hospital | Fertility Preservation for People with Cancer Clinical Reference Document

The Royal Women’s Hospital | Tissue cryopreservation program

In Time program | Free Australia-wide fertility counselling, tissue transport, and cryopreservation for cancer patients up to 24 years of age