Research suggests that maintaining reproductive potential is important to people affected by cancer.(10) However, some studies show that many oncologists either do not discuss fertility issues at all or do so inadequately.(10)

Methods of fertility preservation continue to develop but most are still experimental and more data is needed to establish their efficacy and reliability. Detailed analysis of the subject is beyond the scope of this document but the following is a brief overview of the current situation.

Sperm cryopreservation

Developments in In-vitro fertilisation (IVF) technology and sperm banking techniques mean that cryopreservation of sperm is an accepted and effective method of preserving fertility for men.(21)

Ideally sperm banking should be done before treatment starts. It is recommended that 3 samples (with 48 hours abstinence between samples) are stored.(21) However, advances in reproductive technology mean that even very small samples can result in successful outcomes. Intra-cytoplasmic sperm injection (ICSI) allows the injection of a single sperm into an egg. This means that even men with poor sperm quality can still achieve pregnancy.(21)

There are case reports of successful cryopreservation using sperm obtained from methods other than masturbation. For example; rectal electro ejaculation under anaesthetic and testicular sperm aspiration. These methods are experimental.(10)

Gonadal shielding during radiotherapy

This involves the use of shields to reduce the dose of radiation delivered to the testicles. The evidence for this comes from small case series and shielding is only possible with selected fields.(10)

Hormonal gonadoprotection

This is the use of hormonal therapies (GnRH analogs or antagonists) to protect testicular tissue during chemotherapy or radiotherapy. A review of the literature by an expert panel from the American Society of Clinical Oncology (2006) found that studies did not support the effectiveness of this approach.(10)

Testicular tissue cryopreservation

This involves freezing testicular tissue with a view to reimplanting it following treatment. It has not yet been tested in humans.

The options for women depend on factors such as; age, type of treatment, availability of a partner and whether the cancer has affected (or spread to) her ovaries.

Embryo cryopreservation

A woman's eggs are harvested, fertilised in vitro and then frozen. This means she needs a partner (or donor sperm), and must undergo 10–14 days of ovarian stimulation. It is therefore not recommended for women with breast cancer. Lee et al state that embryo cryopreservation is currently the most established technique for fertility preservation in women.(10)

Oocyte cryopreservation and transplantation

This involves freezing ovarian tissue and reimplanting it after treatment. So far two live births have been reported but this method is still considered experimental.(10)

Gonadal shielding during radiotherapy

This uses shielding to reduce the dose of radiation delivered to the ovaries. Evidence comes from case series and suggests that it is only possible with selected radiation fields.(10)

Trachelectomy

For women with early stage cervical cancer, surgical removal of the cervix (but not uterus) can be successful as a means of preserving fertility. There is a growing body of evidence to support trachelectomy: however, the expertise is not widely available.(10)

Ovarian suppression with hormonal therapies

GnRH analogs or agonists are used to protect ovarian tissue during chemotherapy or radiotherapy. There is some evidence from small studies to support this approach but larger randomised trials are needed.(10)

Ovarian transposition (oophoropexy)

This is the surgical repositioning of the ovaries so that they are out of the radiation field. For women having only radiation therapy this may be an acceptable option. However, ovarian failure may occur if the ovaries are not moved far enough. Also, Fenig et al (quoted in Falcone & Bedaiwy, 2005) recommend delaying pregnancy for one year post-treatment to reduce the risk of miscarriage.(3)