Condition & Treatments
/ Fertility preservation
Starting cancer treatment? Protect your fertility first, quickly.
Chemotherapy, radiotherapy and some surgery can reduce or stop sperm production, sometimes permanently. Freezing sperm before treatment begins keeps the option of a biological child open. It can usually be arranged within days, so it doesn't delay your cancer care
I N S H O R T
Sperm should be frozen before the first dose of chemotherapy or radiotherapy, as sperm collected soon after treatment starts carries a higher risk of genetic damage [5].
Many men can't produce a usable sample, because the cancer itself has stopped sperm production or because they are too unwell to ejaculate. For them, surgical sperm retrieval is the key option.
After treatment, your fertility can be checked and, if needed, treated
Why many men need surgical sperm retrieval
Cancer can reduce sperm production before any treatment begins. In 20–50% of men, sperm production is already impaired at diagnosis, and some men with testicular cancer or lymphoma have no sperm in the semen at all [3, 7]. Others are too unwell, in too much pain or too distressed to produce a sample, or can't for cultural or religious reasons [9]. For these men, sperm can be taken directly from the testis. Guidelines recommend this when a semen sample isn't possible [5]. In published series, sperm was found and frozen in about 43–58% of men before cancer treatment, and in 32–76% after treatment, depending on the type of cancer [8]. Chemotherapy can usually start without delay, often on the same day as the retrieval [9].
Ways to collect sperm
A semen sample,
frozen in several portions at a licensed sperm bank
Electroejaculation,
under anaesthetic, if ejaculation isn't possible because of illness, pain or nerve damage.
Surgical sperm retrieval
(micro-TESE), if no sperm is found in the semen. It can sometimes be done during other planned cancer surgery, such as removal of a testicle (onco-TESE).
After treatment
Semen analysis, usually from around 12 months after treatment ends, then repeated. Sperm counts are often lowest 6 to 12 months after treatment and improve from about 18 months, and men are usually advised to wait around 2 years before trying for a pregnancy naturally [3, 6].
Hormone profile, as treatment can also lower testosterone.
Treatment of any remaining problem, including micro-TESE if sperm production hasn't returned.
Why this matters to your care
Time matters. Prof Raheem works with oncology teams to arrange collection quickly, including in men too unwell to produce a sample.
How quickly can this be done?
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Usually within days. Good practice is to store at least two samples over about a week before treatment starts, but even a single sample is worthwhile if time is short [2].
Is it funded by the NHS?
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Often, yes. NICE recommends that men preparing for cancer treatment that may affect fertility are offered sperm freezing, and the usual NHS fertility eligibility rules don't apply [1, 2]. Your oncology team can refer you.
How long can sperm be stored?
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Up to 55 years in the UK, with consent renewed every 10 years [4].
Can teenagers freeze sperm?
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Yes, with consent and support suited to their age.
Prof Raheem's published work on this topic
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Surgical sperm retrieval (book chapter). Surgical Procedures for Core Urology Trainees. Springer, 2018.
References
1. NICE. Fertility problems: assessment and treatment (CG156), and Quality standard QS73, statement 9: Cryopreservation before cancer treatment. Link
2. NHS Nottingham and Nottinghamshire ICB. Policy for commissioning cryopreservation for patients due to start treatment likely to permanently affect their fertility. Link
3. Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders. Asian Journal of Andrology, 2013. Link
4. Human Fertilisation and Embryology Authority. New law comes into force giving greater flexibility for fertility patients. July 2022. Link
5. American Society of Clinical Oncology. Fertility preservation in people with cancer: updated guideline. Journal of Clinical Oncology, 2025. Link
6. Farnetani G, et al. Long-term effect of cytotoxic treatments on sperm DNA fragmentation in patients affected by testicular germ cell tumor. Link
7. Schrader M, et al. “Onco-TESE”: testicular sperm extraction in azoospermic cancer patients before chemotherapy — new guidelines? Urology, 2003. Link
8. Ogouma L, Berthaut I, et al. Testicular sperm extraction (TESE) outcomes in the context of malignant disease: a systematic review. Asian Journal of Andrology, 2022. Link
9. Berookhim BM, Mulhall JP. Outcomes of operative sperm retrieval strategies for fertility preservation among males scheduled to undergo cancer treatment. Fertility and Sterility, 2014. Link