To Freeze or Not to Freeze: When Is the Question

When we think about cancer and treatment, we often picture older patients who have lived many years and now face a new challenge. What if you are 25, married or single, and you have just found out you have cancer? This is devastating enough for an older adult, but for someone who has not had a chance to live long, have children, see grandchildren, and grow old, this is horrifying.

If you think that is an exaggeration, ask any newly diagnosed younger adult or any oncology nurse, and they will agree with that statement. I have seen the faces of these patients — the whirlwind of fear, anxiety, and questions not only about treatment, but also about the future, including family and, of course, death.

Working in a cancer center as a nurse for many years, I have seen a multitude of young men, women, and couples being hit with a new diagnosis of cancer. According to the American Cancer Society, the incidence of newly diagnosed cancer in adults aged 20–39 is approximately 80,000 each year. Young women are more likely to be diagnosed than young men, but both may be equally likely to die. The most common cancers include breast, thyroid, colorectal, testicular, melanoma, and uterine cancers.

We have come so far in the world of oncology treatment, and this is great news. Treatment choices for most cancers have, in some cases, cured them and, in other cases, made them almost chronic diseases. Available testing, imaging, genetic testing, biomarker testing, and immunotherapies have given physicians a much larger range of therapies to use. Oncology nurses are usually the first to meet patients, as they often gather history before the provider enters the room.

Nurses play a significant role in ensuring that important conversations happen at the very beginning of treatment. Most oncology physicians are very aware of this need, but at times are focused on treatment and how they can help patients achieve cure or extend life. Fertility is not always the first consideration. As nurses, gentle reminders and providing materials that include specialists can give providers and patients more tools. The nurse is often able to have a more personal conversation and may feel less intimidating than the physician. Nurses can foster a higher level of trust, comfort, and accessibility.

Cancer treatment can damage the testicles or ovaries, leading to temporary or permanent infertility. Chemotherapy, radiation, and surgery can all have lasting effects on reproduction. Chemotherapy works to destroy or slow the growth of cancer cells, but it can also damage healthy cells. Men have a longer reproductive window, so age is less of a factor; however, treatment can still cause fertility issues, especially in prostate, testicular, and colon cancers.

For women, the ovaries are very sensitive, and treatment will often stop menstrual cycles and ovulation, potentially inducing a menopausal state. Some chemotherapy drugs may interrupt the menstrual cycle permanently, and it may not return. This depends on the type of chemotherapy, dose, treatment duration, and proximity to natural menopause.

For men, chemotherapy can damage sperm and reduce the ability to produce new sperm. As with women, these effects may be temporary or permanent depending on the drugs, dose, age, and other factors.

Radiation therapy in or near the pelvic region can destroy eggs, damage the ovaries and uterus, and reduce sperm production.

Within the extensive information provided to patients at diagnosis, it is difficult for individuals to know what to ask. Many young men, particularly those who are single, do not ask about sperm preservation. Studies indicate that only 24% to 53% of young male patients undergo sperm banking, possibly due to embarrassment, lack of knowledge, or shock. According to an Everyday Health study, an average of 42% of women seek egg preservation.

Enter egg (oocyte cryopreservation) and sperm (sperm cryopreservation).

According to Andreana Holowatyj, PhD, MSCI, ASCO, 2025, only approximately half of newly diagnosed cancer patients of childbearing age are introduced to fertility preservation before treatment. Only one out of every two patients (50.7%) reported that a provider discussed fertility preservation options before treatment began. The likelihood of these discussions varied by age, pregnancy history, marital status, and cancer type. The lowest prevalence of discussions occurred among patients with thyroid (3.6%), lung or bronchial (21%), ovarian (21.4%), and colorectal (44.2%) cancers.

If these conversations do not occur at the time treatment options are introduced, treatment may be delayed if patients later pursue preservation, which happens more often than desired. There are options for egg preservation after chemotherapy begins, known as rescue ovum or emergency cryopreservation, but these are generally less successful and highly time sensitive, often within the first 48 hours after treatment begins. Urgent consultation with a reproductive endocrinologist or oncofertility specialist is required. Oncology nurses can help expedite this process or prevent the need for urgent referral after treatment initiation, reducing additional stress for patients.

There are many factors to consider with fertility preservation, including disease stage, overall health, insurance coverage, and cost. Emerging techniques are making the process safer, faster, and more accessible. Nurses can play a key role in ensuring patients receive this information.

As oncology nurses, we play a critical role at the front end of these concerns. We can initiate conversations, provide resources, and ensure that fertility preservation is included in the care plan. By educating ourselves, we can engage in informed discussions with both providers and patients. This is an opportunity to contribute meaningfully to the future quality of life for cancer survivors and, potentially, to the next generation.

References

1. Su HI, Lacchetti C, Letourneau J, et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J Clin Oncol. 2025; Volume 43, Number 12. doi: 10.1200/JCO-24-02782.
2. Doungkamchan C, Orwig KE.. Recent advances: fertility preservation and fertility restoration options for males and females. Fac Rev. 2021; 10:55. doi: 10.12703/r/10-55.