• Annually, approximately 150,000 men and women are diagnosed with cancer during their child-bearing years. The gonadotoxic therapy used to treat a variety of cancers can leave patients permanently infertile.*
• The possibility of having a family after treatment is much more likely as survival rates** for cancer patients have grown dramatically over the past twenty years.
• Advancements in reproductive medicine over the past twenty years make having a family of your own more possible now than ever before.

*American Society for Reproductive Medicine.
**American Cancer Society Facts and Figures 2020.

As you may have learned already, the cytotoxicity of chemotherapy is not limited to cancer cells. Many other cells in the body are also affected, including hair, mucosal membranes, and the germ cells that produce eggs and sperm.

Radiation Treatment:

• • Typically, decreased fertility or infertility is temporary in men when only radiation treatment is used, however, every case is different. Discuss your specific treatment and possible side effects with your physician(s).
  • Infertility risk in females is less understood, however direct exposure of the ovaries to high amounts of radiation has been shown to cause long-term loss of fertility.

During treatment, the prevention of pregnancy is very important, due to the risk of birth defects, stillbirths, miscarriages, or spontaneous abortions.

Although chemotherapy and ionizing radiation cause significant DNA injury, the potential for transmitting genetic defects to offspring after treatment cycles are complete is remote.

After treatment cycles are complete, no significant increase in major or minor genetic defects has been observed in the offspring of parents who have had cancer or undergone cancer therapy.

Abnormalities in sperm DNA prevent the introduction of damaged DNA into the oocyte. It is reasonable to recommend, however, that men delay attempting to father children for 6 months after completing chemotherapy or radiation therapy, to allow regeneration of developing spermatozoa.

For a more detailed breakdown of how cancer treatments impact reproductive health, please visit the National Comprehensive Cancer Network.

Military members who wish to preserve their fertility before deployment often will freeze sperm, oocytes, or embryos to safeguard their options for future family building. With active duty comes the risk of infertility for some service members. Freezing specimens before deployment will ensure your fertility is protected and is also available, with your consent, for a spouse or partner to use to achieve pregnancy while you are separated. And ReproTech offers discounted specimen storage for active-duty personnel.

Because gender-affirming hormone replacement therapy (HRT) has the possibility to negatively impact future fertility, many trans people choose to preserve and protect their fertility before beginning HRT and will work with a fertility clinic or sperm bank to freeze oocytes, embryos, or sperm for future family building.

Some programs also offer ovarian tissue or testicular tissue cryopreservation for adolescents who meet certain criteria and do not wish to do ovarian stimulation for oocyte collection or produce a sperm sample. Visit the Fertility Preservation in Pittsburgh at UPMC for more information or call them at 412-641-7475.

For sperm collection in the privacy of your home, we offer our OverNite Male kit. However, please note that sperm frozen with this kit can only be used with a sexually intimate partner, and is not meant for use as donor sperm or with a gestational carrier or surrogate in the future. If you want to use your sperm with someone who is not your sexually intimate partner or if you anticipate using a gestational carrier, please contact a fertility clinic or sperm bank to assist you with additional directed donor testing and screening.

• Cryopreservation is the ultra-low temperature storage of cells or groups of cells.
• Cryopreservation causes the cessation of cellular activity through the removal of water and the addition of cryoprotectants.
• Through cryopreservation, reproductive tissue can be cooled to stable conditions that can preserve cells. ReproTech then receives cryogenically frozen specimens and tissue, which we safely store until they are ready to be used.

• Sperm was first cryopreserved in the 1950s. Since then, millions of animals have been born through the use of cryopreserved (frozen) sperm. The use of cryopreserved human sperm has been in widespread use since the 1980s.
• Embryo cryopreservation was first used in various farm animals in the 1970s and is a very common procedure today in human infertility treatment.
• Cryopreservation of oocytes (eggs) is still relatively new (past 10 years).

• We really can only rely on estimated calculations that predict the answer to be 2,000 to 4,000 years.
• Storage periods of more than 40 years for sperm and 20 years for embryos prior to pregnancies established have been documented, but these records will be broken.
• There is no evidence to suggest that the health or viability of frozen eggs, semen, or embryos decreases with cryopreservation and long-term storage. In theory, frozen eggs or embryos can be stored indefinitely.

Sperm banking is the collection, cryogenic freezing, and storage of human sperm. The sperm can be used for artificial insemination or IVF procedures for future family building.

Specimens are collected via masturbation/ejaculation either on-site at a reproductive laboratory or off-site and transported to the facility.

The most convenient, secure, private, and cost-effective method available for off-site sperm collection is ReproTech’s OverNite Male kit

Alternative collection processes include:

• Electroejaculation
• TESE – Testicular Epididymal Sperm Extraction (essentially a needle biopsy)
• Testicular Biopsy (open biopsy)

The total cost to freeze sperm will be dependent on the number of specimens banked as well as the facility which you use. The number of specimens required really is dependent on the sperm quality, the number of specimens, and functionality.

More information on the costs of sperm storage can be found on ReproTech’s fee schedule for sperm storage.

• IUI (Intra Uterine Insemination)
  • Involves the monitoring (timing) of ovulation in the female, and then insemination into the uterus using a catheter.
  • Pregnancy rates (13-23%, age dependent)
  • Costs ($1,000 non-medicated)
• IVF (In Vitro Fertilization)
  • Involves the ovarian stimulation of the female followed by the retrieval of eggs and subsequent fertilization of the eggs in the laboratory prior to the transfer of the fertilized eggs (embryos) back to the female.
  • Pregnancy rates (Age-dependent 35-50%)
  • Costs ($8,000-$12,000) / cycle, however, in some states there is insurance coverage and many clinics offer Shared Risk plans)
• ICSI (Intra Cytoplasmic Sperm Injection)
  • First utilized in the US in 1994, just a little more than 10 years ago.
  • Enables the use of extremely low numbers of sperm. In fact, pregnancies have been achieved with sperm numbers in the single digits.
  • Allows the use of sperm retrieved by:
    • TESE
    • Electroejaculation
    • Testicular Biopsy
  • Pregnancy rates (age-dependent 35-50% – same as IVF)
  • Costs (adds about $1,000 to $1,750 to IVF cost)

Embryo Freezing

– Excellent pregnancy rates

– Both oocytes and sperm are needed to create embryos using a couple’s own oocytes and sperm, or with donor oocytes or donor sperm.

– Ovarian stimulation is required to increase the number of mature oocytes available for fertilization. Previously this was concerning for cancer patients who would need to delay treatment in order to freeze oocytes. New expedited stimulation protocols now allow clinics to complete oocyte retrieval faster, so fertility preservation is possible for more patients.

– Recent research shows that some breast cancer patients may be safely stimulated by tamoxifen or letrozole.

– In Vitro Maturation is another area being studied in an attempt to find methods of limited estrogen exposure.

Oocyte (egg) freezing

– Cryopreservation of oocytes allows a patient to freeze their gametes for future use in creating embryos. Some patients who have a partner will freeze both oocytes and embryos so they have all options available for future family building.

– Oocyte freezing has become increasingly common for fertility preservation as vitrification has improved the post-thaw survival rates of oocytes significantly in recent years. Vitrification is the process of freezing oocytes into a glass-like state (thus avoiding crystallization) by removing water from within the oocyte and replacing it with a cryoprotective substance to prevent damage to the oocyte as it is frozen.

Ovarian tissue freezing

This procedure involves:

• Laparoscopic surgical removal of one ovary.
• Slicing of thin strips of the exterior of the ovary
• Cryopreservation of those strips
• Storage for future transplant back into the patient or in-vitro maturation of the ovarian tissue and oocytes

Picture of the ovarian tissue transplant procedure.

Pregnancy after Transplantation of Cryopreserved Ovarian Tissue in a Patient with Ovarian Failure after Chemotherapy, Meirow, et.al, New England Journal of Medicine, June 27, 2005, Online Content.

For the latest developments on this procedure, read more at the NCBI.

• Ovarian transposition – Surgical procedure: “A procedure used to help keep a woman fertile by preventing damage to the ovaries during radiation therapy. Before radiation therapy begins, one or both ovaries and fallopian tubes are separated from the uterus and attached to the wall of the abdomen away from where the radiation will be given. Ovarian transposition may be useful for women who want to have children after having radiation therapy that can cause infertility. It is a type of fertility preservation. Also called oophoropexy.” From the National Cancer Institute.
• GNRH agonist treatment during chemotherapy

Oocyte (egg) freezing

Freezing costs: $7,000-$12,000

Storage – See all Oocyte storage fee options.

$5,000 estimated lab & clinical services at thaw

Pregnancy rates vary between 2% to 4% per oocyte

Embryo Freezing

Costs: $13,000- $25,000 – depending on whether genetic testing (PGS) and intracytoplasmic sperm injection (ICSI) is done or not.

Storage – See all Embryo storage fee options.

$1,700-$2,500 estimated lab & clinical services at thaw

Pregnancy rates: 20-30% per cycle

Ovarian Tissue Freezing

Costs: $6,000 to $8,000, after subsidization by hospital and/or surgeon

Storage – See all Ovarian Tissue storage fee options.

Pregnancy rates (Limited cases, no general estimates available)

THIRD-PARTY REPRODUCTIONS

Sperm Donor

A sperm donor may be chosen by couples unable to produce children due to male infertility or by individuals without a sperm source. A donor may be chosen by the recipient (“known” donor), or recipients may choose an anonymous or non-anonymous donor via a sperm bank or agency. Pregnancy is achieved by using ART procedures. The costs of donor semen purchased from a sperm bank range at price from $200-$700 per vial. Additional insemination costs vary depending on the cycle type. Shipping and storage fees may also apply.

Egg (Oocyte) Donor

An egg (oocyte) donor may be chosen when an individual is unable to produce their own eggs (oocytes). A donor may be chosen by the recipient (“known” donor), or recipients may choose an anonymous or non-anonymous donor via an egg donation agency. The donor receives fertility medications to stimulate the production of multiple eggs. The eggs (oocytes) are then fertilized with a sperm source in a laboratory and the embryos are transferred into the recipient’s uterus. The fees paid to an egg donor and/or agency are in the $5,000-$15,000 range, with additional costs for ART procedures. Storage fees for additional embryos may also apply.

Donor Embryos

Once their family is complete, some people opt to donate excess embryos. Embryo donors complete a three-generation medical/genetic history, a psycho/social evaluation, additional blood testing, and sign an informed consent and agreement to donate. While there are many programs across the United States that administer embryo donation, there generally are waiting lists from a few months to a year or more to receive embryos. The costs to use donated embryos generally range from $2,000 to $5,000 for the above-listed embryo donor screening and legal agreements and then $2,000 to $5,000 for the frozen embryo transfer.

Gestational Carrier (Surrogate)

A gestational carrier is a person who carries a pregnancy for another person or couple. The intended parent may provide the egg (oocyte), or a donor egg used, to create the embryo, and then it is transferred to the gestational carrier’s uterus. This method is sometimes chosen when a patient has had her uterus removed, has a serious medical condition, or when recurrent IVF failure is an issue. A gestational carrier is selected through an agency or organization, with signed consent from all parties. Gestational carrier costs range from $10,000-$100,000, and costs for assisted reproductive procedures will also apply as well as storage fees. The legal status of using a gestational carrier varies by state, so it is important that a knowledgeable and reputable attorney/agency be utilized.

Alliance for Fertility Preservation

American Association of Tissue Banks

American Society of Reproductive Medicine

CoFertility

LiveStrong Fertility Program

SaveMyFertility.org

Oncofertility Consortium

Resolve

Gay Parents to Be

Compassionate Corps

ReUnite Assist for Veterans

National Center for Biotechnology Information

NIH (National Cancer Institute)

• American Society of Clinical Oncology Fertility Preservation Guidelines
• ASRM Ethics Committee Opinion
• A predictive model for chemotherapy-related diminished ovarian reserve in reproductive-age women
• Fertility Preservation Before Cancer: Options, Strategies, and Resources 
• Female Cancers, Cryopreservation, and Fertility Fact Sheet
• Male Cancer, Cryopreservation, and Fertility Fact Sheet
• The pediatric patient and future fertility: optimizing long-term male reproductive health outcomes 
• Fertility preservation in patients with breast cancer does not appear to affect long-term cancer outcomes even if performed prior to breast surgery 
• Leukemia & Lymphoma Society’s Fertility Fact Sheet
• Long-Term Effects of Cryopreservation on Human Spermatozoa

• Oocyte vitrification for fertility preservation for both medical and nonmedical reasons

• New Insights for fertility preservation by ovarian tissue cryopreservation and transplantation in pediatric cancer patients 
• Semen Parameters of Cancer Patients at Diagnosis
• Sperm cryopreservation prior to gonadotoxic treatment: experience of a single academic centre over 4 decades

• Update on fertility preservation from the Barcelona International Society for Fertility Preservation

• Long-term cryostorage of semen in a human sperm bank does not affect clinical outcomes

• Live births from frozen human semen stored for 40 years

• Fertility issues in Girls and Women with Cancer