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Some treatments like chemotherapy, radiation, surgery or a blood and marrow transplant (BMT) used to treat cancer, blood disorders or other serious illnesses may damage the ovaries or testes. By cryopreserving (freezing) sperm, eggs or tissue from the ovaries or testes, patients have options if they experience infertility, or difficulty having children, in the future. The process of saving reproductive materials and utilizing fertility-sparing methods is called fertility preservation.

The team at the Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta offers fertility preservation as a continuum of care, treating not only the diagnosis at hand but preserving patient health and wellness into the future after treatment is over.

In our Fertility Preservation Program, we recognize that it is very important to patients to preserve their ability to have children in the future. When these treatments are needed, our team works with patients and their families to help make sure they understand their risk of infertility and their options for fertility preservation.

The Aflac Cancer and Blood Disorders Center Completed Its 1,000th Fertility Evaluation

In April 2021, our Fertility Preservation Program team completed its 1,000th fertility evaluation. This milestone highlights our dedication to helping patients preserve their ability to have children in the future by explaining the risk of infertility and providing alternative fertility preservation options.

Fertility Preservation at a Glance

There are many fertility preservation options available for patients who are planning to undergo treatments that may damage ovaries or testes. The best option for each patient depends on many factors, including age, pubertal status, diagnosis, planned treatment and the amount of time available prior to beginning treatment.

Fertility preservation options must be individualized. Most fertility preservation options should be done before treatment, and we can discuss both standard of care and experimental options with families. We also offer counseling for patients and families after treatments that may affect fertility, we assist with fertility status assessment and our team provides information about possible fertility preservation options at that time. 

Before Treatment

Standard of care:
These treatments are clinically accepted and endorsed by the American Society of Clinical Oncology and the American Society of Reproductive Medicine.

Embryos are eggs that have been fertilized by sperm and can grow and develop into a baby. Embryo cryopreservation (freezing) is the process of stimulating ovaries to produce many mature eggs, collecting eggs from the ovaries, combining them with a male partner or donor’s sperm in the laboratory to create embryos, and freezing the embryos for future use. It is used as a means of preserving fertility before treatments that might cause infertility, such as certain surgeries, some types of chemotherapy, radiation or a BMT. The treatment is done by a specialized doctor called a reproductive endocrinologist, and the embryos are frozen and stored at facilities known as assisted reproductive centers.

Any female who has a partner with whom she wishes to have children might consider freezing her embryos before starting a treatment that could place her at risk for infertility. Only females that have started having their period are able to undergo embryo cryopreservation. Also, the process involves uncomfortable procedures (see below) that need to be considered before choosing this option.

Note: For younger females or those who do not have a partner with whom they want to have children, oocyte cryopreservation (egg freezing) is recommended. See the section above on oocyte cryopreservation to learn more.

Injected medicines that stimulate the ovaries to produce many mature eggs are given daily for about 10 to 14 days. During this time, the patient may need to make frequent visits—daily to every other day—to the reproductive endocrinologist to have blood tests and vaginal ultrasounds to monitor the ovaries’ response to the medicines. After the reproductive endocrinologist decides the patient is ready, the patient will undergo an egg retrieval procedure that is done under sedation as an outpatient. During this procedure, eggs are collected using a needle that is placed through the vaginal wall while the patient is sedated. The collected eggs are then combined with a fresh or frozen sperm specimen from the desired partner or donor through a process known as in vitro fertilization (IVF). The resulting embryos are then matured for a few days and frozen for future use. The patient goes home the same day and usually can resume her normal activities the following day.

Note: When embryos are frozen in this way, a procedure known as an embryo transfer is required in order to achieve pregnancy in the future.

Embryo cryopreservation is best if done before a person starts any treatment that can affect fertility. It can take up to two weeks to complete the process. Reproductive endocrinologists are often able to start the process quickly for patients who are going to receive treatment that may damage the ovaries. In many cases, embryos can be frozen before a patient begins treatment. However, in some cases there is not enough time to freeze embryos before beginning treatment, or certain conditions may prevent patients from being healthy enough to undergo embryo freezing. In these cases, it is possible to monitor a patient after the completion of treatment. If after treatment a patient appears to have a greatly reduced number of eggs, and therefore a limited number of years to have a child, then the patient can be referred to a fertility clinic for evaluation for possible fertility treatments.

Discuss embryo cryopreservation with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Oocyte cryopreservation (egg freezing) is the process of stimulating the ovaries to produce many mature eggs, collecting the eggs and freezing them for future use. It is often used as a means of preserving fertility, especially before treatments that might cause infertility, such as certain surgeries, some types of chemotherapy, radiation or a BMT. It is a proven and established method of preserving fertility in females and is accepted by the American Society of Clinical Oncologists and the American Society of Reproductive Medicine. The treatment is done by a specialized doctor called a reproductive endocrinologist, and the eggs are frozen and stored at facilities known as assisted reproductive centers.

Females planning to start a treatment that may have negative effects on fertility might wish to consider freezing eggs beforehand. Only females that have begun menses (started having their period) are able to undergo oocyte cryopreservation. Also, the process involves uncomfortable procedures (see below) that need to be considered before choosing this option.

Injected medications are given daily for about 10 to 14 days. These stimulate the ovaries to produce many mature eggs. During this time frame, the patient may need to make visits—daily to every other day—to the reproductive endocrinologist to have blood tests and vaginal ultrasounds to monitor the ovaries’ response to the medications. After the reproductive endocrinologist decides the patient is ready, the patient will undergo an egg retrieval procedure that is done outpatient and under sedation. During this procedure, eggs are collected using a needle that is placed through the vaginal wall while the patient is sedated. The eggs are then frozen for storage. The patient goes home the same day and usually can resume her normal activities the following day.

Oocyte cryopreservation is best if done before a person starts any treatment that can affect fertility. It can take up to two weeks to complete the process. Reproductive endocrinologists are often able to start the egg freezing process quickly in patients who are going to receive treatment that may damage the ovaries. In many cases, a patient’s eggs can be frozen before she starts treatment. However, in some cases there is not enough time to freeze eggs before a patient begins treatment, or certain conditions may prevent patients from being healthy enough to undergo egg freezing. In these cases, it is possible to monitor a patient after the completion of treatment. If after treatment a patient appears to have a greatly reduced number of eggs, and therefore a limited number of years to have a child, the patient can be referred to a fertility clinic for evaluation for fertility preservation.

You can discuss oocyte cryopreservation with your provider or with a member of the Fertility Preservation Program team by calling 404-785-6985.

Ovarian tissue cryopreservation is the removal of one ovary and freezing the parts that contains oocytes (eggs) for possible future use. The ovary is removed laparoscopically in the operating room, divided into strips and then frozen. This is the only method of fertility preservation available to girls before they enter puberty. It is also an option to preserve fertility in some older girls who cannot delay the start of treatment to stimulate the ovaries to harvest eggs (oocyte cryopreservation). Treatments that may cause infertility include some types of chemotherapy, radiation or a blood and marrow transplant (BMT). Before 2019, ovarian tissue cryopreservation was considered experimental by the American Society of Reproductive Medicine. It is no longer experimental based on many babies born using this method in adolescent young adult women. However, there has been limited success in tissue taken from girls before they enter puberty. Many studies are underway to study the use of ovarian tissue cryopreservation in pediatric and adolescent patients. If you choose this procedure you may be asked to participate in such a study.

Females at significantly high risk for infertility due to their planned treatment may wish to consider ovarian tissue cryopreservation. This is the only type of fertility preservation available to young girls before the onset of puberty. It can also be offered to some adolescent young adult females and is an important option when therapy cannot be delayed to stimulate the ovaries for egg harvest and freezing (oocyte cryopreservation).

One ovary is removed laparoscopically. Laparoscopy is a surgery using several small incisions, a camera and special surgical tools that avoid a large incision in the abdomen. Once the ovary is removed the outer portion (which contains the eggs) is processed into strips and frozen. This can often be an outpatient procedure and doesn’t typically require an overnight stay.

Note: When the patient is ready to use the ovarian tissue, it can be transplanted back to the patient if there is no concern of reintroducing cancer through the transplanted ovary. If there is concern, research is underway to determine how to mature the eggs from the frozen tissue in the laboratory and then use in vitro fertilization (IVF) to achieve pregnancy. IVF involves fertilizing eggs with sperm, growing the resulting embryos in an incubator for several days and then transferring an embryo into the uterus. 

Ovarian tissue cryopreservation is best done before a patient receives treatment that places them at significant risk for infertility. Ovarian tissue cryopreservation can be offered to relapsed patients who have been treated with prior therapy that places them at risk for infertility as long as their bloodwork does not show ovarian insufficiency or ovarian failure.

Discuss ovarian tissue cryopreservation with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Sperm cryopreservation, also known as sperm banking, is the process of freezing sperm and storing it for future use. Sperm cryopreservation is often used as a means of preserving fertility, especially before certain treatments that might cause a risk of infertility, such as certain surgeries, radiation, BMT or certain types of chemotherapy. It is the only proven and established method of preserving fertility in males. Frozen sperm is stored at special facilities known as assisted reproductive centers, or sperm banks, and can be stored for many years, possibly indefinitely.

Any male planning to start a treatment that may have negative effects on fertility might wish to consider sperm banking before starting treatment. Males that have reached a certain stage of puberty will have the ability to produce a semen sample. This is around age 13 for most boys but can vary.

Sperm is isolated from a patient’s semen. Semen is most often collected by masturbation. If this is not possible or successful, other options might be considered. After a patient produces a semen sample, it is quickly delivered to an assisted reproductive center or sperm bank for processing and freezing.

Sperm cryopreservation should be done before a person starts any treatment that may affect fertility. The patient can choose to freeze as many samples as he wishes before starting treatment.

You can discuss sperm banking with your provider or with a member of the Fertility Preservation Program team by calling 404-785-6985.

Other Nonexperimental Options Before Treatment

These treatment options have shown some evidence of being beneficial but have not yet become standard of care for fertility preservation.

Gonadotropin agonists, such as leuprolide or Lupron Depot, are medicines that suppress the ovaries, making them less active. With this medicine, the ovaries will not make female hormones; therefore, the patient will not have a period. Not having a period may be good since some patients have very heavy periods while on cancer treatment due to lower platelet levels in the blood. Also, some doctors think less active ovaries may be less likely to be damaged by cancer treatments since being treated for cancer before puberty—when the ovaries are not active—seem to be less harmful. However, this idea is not yet proven by research. Once gonadotropin agonist is stopped after chemotherapy is complete, the ovaries, if not damaged by cancer therapy, will begin producing hormones and periods in six to 12 months. However, if the ovaries have been damaged by cancer therapy, it may take one to two years for hormone production to return.

Note: For some patients with severe damage to the ovaries, ovarian function may not return.

Any female patient who is having periods and is expected to have low blood counts during chemotherapy may be offered gonadotropin agonist by the treating oncologist in hopes of stopping all periods during treatment.

Gonadotropin agonist is usually given as an injection into the muscle every three months. Since gonadotropin agonist shuts down ovarian hormone production, girls may feel symptoms like hot flashes, night sweats and mood changes. You may be prescribed a pill to help with these symptoms.

Gonadotropin agonist should be started before chemotherapy, ideally two to three weeks before therapy starts. However, this is not always possible.

Discuss gonadotropin agonist with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Ovarian transposition is a procedure performed on females who will need radiation to the pelvis, which is the location of the uterus and ovaries, as part of their treatment. It is done to help protect the ovaries from the damaging effects of radiation by moving them away from the pelvis. This procedure may help the ovaries continue to produce female hormones and eggs after treatment. However, it does not protect against the damaging effects of chemotherapy to the ovaries or radiation to the uterus.

A female patient of any age who requires radiation therapy to the pelvis might consider ovarian transposition.

This procedure is usually done as a laparoscopic surgery and requires several small incisions in the abdomen. It involves moving the ovaries away from their normal position in the pelvis to an area of the pelvis or abdomen that is outside the location where radiation will be directed.

Ovarian transposition should be done before starting radiation treatment and can be combined with other planned surgical procedures that a patient may have, like port placement.

Discuss ovarian transposition with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Testicular transposition is a small surgery in which one or both testes are moved from the scrotal sac to a position outside the planned area of radiation, such as the upper thigh. It is done to help protect the testes from the damaging effects of radiation. The procedure may help the testes continue to be able to produce male hormones and sperm after treatment. This procedure does not protect the testes from the damaging effects of chemotherapy.

All male patients who are scheduled to undergo radiation of an area on the body that would result in radiation exposure to the testes might consider this option. A patient who will also be receiving chemotherapy that could damage the testes should not consider this option. Patients who will receive radiation of the testes as part of their cancer treatment do not qualify for testicular transposition.

A small incision is made in the groin and the testes are relocated into a pouch in the thigh. This surgery can be combined with other planned surgical procedures, such as port placement. After radiation therapy is completed, another surgery is needed to move the testes back into the scrotal sac. This utilizes the same groin incision and an additional small incision on the scrotal sac.

Testicular transposition can be done anytime before radiation treatment begins, ideally one to two weeks before treatment in order to allow the wounds to heal and discomfort to subside.

Discuss testicular transposition with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Experimental Options Before Treatment

Experimental treatment options are procedures that are not yet medically proven methods of fertility preservation and are considered experimental (only done under research protocol).

Testicular tissue cryopreservation is the removal of a small piece of one testis and freezing this tissue that contains cells that will one day make sperm. This is the only method of fertility preservation that can be offered to boys before they enter puberty. Fertility preservation is offered before treatments that may cause infertility which include some types of chemotherapy, radiation, blood and marrow transplant (BMT) and some surgeries. Testicular tissue cryopreservation is experimental and can only be done under an institutional review board (IRB) research protocol. There have been no human babies born from testicular tissue cryopreservation.

Males at significantly high risk for infertility due to their planned treatment may wish to consider testicular tissue cryopreservation. This is the only type of fertility preservation that can be offered to young males before the onset of puberty. It can also be offered boys who are older and who cannot produce a semen specimen or in whom mature sperm cannot be found on testicular biopsy.

A testicular biopsy is done in the operating room. It is typically an outpatient procedure. This tissue is then processed and frozen for long term storage.

Note: When the patient is ready to use the testicular tissue, it can be transplanted back to the patient if there is no concern of reintroducing cancer through the transplanted tissue. If there is concern, research is underway to determine how to mature sperm in in the laboratory to use for in vitro fertilization (IVF) which can be used to achieve pregnancy. IVF involves fertilizing eggs with sperm, growing the resulting embryos in an incubator for several days and transferring an embryo into the uterus.

Testicular tissue cryopreservation is best done before a patient receives treatment that places them at significant risk for infertility. Testicular tissue cryopreservation can be offered to some patients who have been treated with prior therapy as long as they have not received an amount of treatment that has permanently damaged their ability to make sperm.

Discuss testicular tissue cryopreservation with your provider, or contact a member of the Fertility Preservation Program team by calling 404-785-6985.

Ideally, fertility preservation is taken into consideration before a patient begins treatment, as it’s important to be proactive when determining a patient’s ability to have children in the future. However, for female patients who have already undergone treatments that may damage their ovaries, premature ovarian failure could occur. In our Cancer Survivor and BMT programs, we try to identify females who are at a high risk for premature ovarian failure and offer oocyte (egg) cryopreservation (freezing) in the early years of survivorship.

Oocyte cryopreservation (egg freezing) is the process of stimulating the ovaries to produce many mature eggs, collecting the eggs and freezing them for future use. It is often used as a means of preserving fertility, especially before treatments that might cause infertility, such as certain surgeries, some types of chemotherapy, radiation or a BMT. It is a proven and established method of preserving fertility in females and is accepted by the American Society of Clinical Oncologists and the American Society of Reproductive Medicine. The treatment is done by a specialized doctor called a reproductive endocrinologist, and the eggs are frozen and stored at facilities known as assisted reproductive centers.

Females planning to start a treatment that may have negative effects on fertility might wish to consider freezing eggs beforehand. Only females that have begun menses (started having their period) are able to undergo oocyte cryopreservation. Also, the process involves uncomfortable procedures (see below) that need to be considered before choosing this option.

Injected medications are given daily for about 10 to 14 days. These stimulate the ovaries to produce many mature eggs. During this time frame, the patient may need to make visits—daily to every other day—to the reproductive endocrinologist to have blood tests and vaginal ultrasounds to monitor the ovaries’ response to the medications. After the reproductive endocrinologist decides the patient is ready, the patient will undergo an egg retrieval procedure that is done outpatient and under sedation. During this procedure, eggs are collected using a needle that is placed through the vaginal wall while the patient is sedated. The eggs are then frozen for storage. The patient goes home the same day and usually can resume her normal activities the following day.

In some cases there is not enough time to freeze eggs before a patient begins treatment, or certain conditions may prevent patients from being healthy enough to undergo egg freezing. In these situations, it is possible to monitor a patient after the completion of treatment. If after treatment it seems that the patient may have a greatly reduced number of eggs, and therefore a limited number of years to have a child, the patient can be referred to a fertility clinic for evaluation for fertility preservation. The team of specialists in the Cancer Survivor Program and BMT Program proactively identify female patients who are at a high risk for premature ovarian failure and offer oocyte cryopreservation (egg freezing) in the early years of survivorship.

You can discuss oocyte cryopreservation with your provider or with a member of the Fertility Preservation Program team by calling 404-785-6985.

Our Fertility Preservation Program team offers four approaches to provide care to patients:

  • Urgent fertility preservation consults: This is for patients who may be candidates for fertility preservation before treatment begins and whose treatment is expected to start very soon. A fertility preservation consult request is placed by the medical team, and the fertility preservation team mobilizes urgently to see the patient in order to discuss risk and fertility preservation options so that sperm, oocyte (eggs) or tissue can be frozen before treatment starts.
  • Nonurgent fertility preservation consults: This is for patients who have time to schedule an appointment with a member of the fertility preservation team. During that visit which can be in person or by telemedicine we will review with the patient and family the risk for infertility based on planned treatment and fertility preservation options that may be appropriate for them.
  • Cancer Survivor Program surveillance: Our Cancer Survivor Program team reviews late effects of treatment, including possible infertility, with patients who have completed their cancer therapy and their families. Tests can be done to assess the endocrine and reproductive function of the ovaries and testes after the end of treatment. Ovarian and testicular late effects of cancer treatment can be diagnosed and managed in this clinic.
  • Fertility Status Assessment: For adolescent and young adult cancer survivors who would like to know their fertility status after the completion of cancer therapy, we offer semen analysis and interpretation for males and ovarian reserve assessment with referral to a reproductive health clinic when appropriate for females.

For all of these services, our fertility nurse navigators are available to expedite access to our team and will assist in helping patients obtain any specialized services necessary.

Receiving a cancer or blood disorders diagnosis for your child can be an emotional and overwhelming experience. At the Aflac Cancer and Blood Disorders Center, we are here to support you and your family. Whether treating a toddler with sickle cell disease during an emergency or helping a teen through chemotherapy treatments, we make it our mission to provide the best care—and best experience—for every child. Family is a big part of your child’s well-being. Not only are you a vital member of your child’s healthcare team; you are a source of security and comfort.

Consult team

  • Lillian Meacham, MD, Pediatric Endocrinology, Director, Fertility Preservation Program
  • James Klosky, PhD, Psychology
  • Megan Pruett, CPNP, Pediatric Endocrinology
  • James Ludemann, RN, CPHON, OCN, Fertility Preservation Nurse Navigator
  • Sonia Hoey, RN, CPN, Fertility Preservation Nurse Navigator
  • Kristin Frazier, LCSW, Social Work Resource, Egleston Hospital
  • Stephanie Burns, LMSW, Social Work Resource, Scottish Rite Hospital

Additional partners