For Cancer Patients of Reproductive Age, Fertility Preservation Is a Crucial Early Consideration

A cancer diagnosis typically focuses the patient’s attention on their treatment options and prognosis. A team approach at Mount Sinai enables patients of reproductive age to consider another vital issue: preserving their fertility, says Alan B. Copperman, MD, Director of Reproductive Endocrinology and Infertility, and Clinical Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai. The team includes geneticists, oncologists, surgeons, immunologists, and any other doctor who diagnoses cancer.

As cancer survival rates continue to climb, more and more young people may find themselves having survived cancer but unable to start a family—the current five-year breast cancer survival rate is 91 percent, according to the American Cancer Society. Patients have a better chance at preserving fertility if they are referred to a reproductive endocrinologist as soon as possible.

“Cancer patients can now focus not only on survival, but on how they think about meaningful survival,” Dr. Copperman says. “And that often means the ability to build a family after treatment.”

Within the Mount Sinai Health System, oncology patients are guaranteed a fertility consultation within 24 hours of diagnosis, whether it is an in-person conversation or a telehealth appointment. “We can get sperm out that day,” says Dr. Copperman, who is also the Managing Director and Chief Executive Officer of Reproductive Medicine Associates (RMA) of New York. “And we can get eggs out within two weeks.” This enables patients to make an informed decision about their future fertility without worrying that it would compromise their survival, he says. Mount Sinai has built relationships with nonprofit organizations, including the Livestrong Foundation, that can help provide financial assistance for fertility preservation.

A retrospective study published by investigators at the Icahn School of Medicine at Mount Sinai and RMA of New York in July 2024 in Gynecologic Oncology found that more than a quarter of patients who froze oocytes/embryos returned to the fertility center to use their stored biological materials to build their families. Between August 1, 2016, and August 1, 2022, 81 Mount Sinai patients found to test positive for hereditary breast and ovarian cancer syndrome (HBOC) genes received a fertility consultation to learn about their reproductive options. Among those patients, 48 (59 percent) ultimately underwent oocyte cryopreservation and 33 (40.7 percent) underwent embryo cryopreservation. Patients who underwent oocyte cryopreservation due to BRCA1 status were more likely to present for fertility consultation at a younger age compared to control patients (32.6 vs. 34.7 years) and were more likely to undergo oocyte cryopreservation at a younger age (32.1 vs. 34.6 years).

“Patients diagnosed with BRCA1 had more oocytes retrieved compared to the control population, which is possibly due to earlier age of presentation in the setting of recommended age of risk reducing surgery being age 35–40,” the study said. “Given the known cancer prevention benefit and recommendations for risk-reducing surgery, future studies should focus on guidelines for fertility preservation for patients with HBOC.”

Earlier research by the team explored fertility preservation in young cancer patients. In this study, published in Fertility and Sterility, a total of 187 cancer patients who underwent fertility preservation were identified and included in the analysis, matched to 374 controls. Among the 187 patients, 146 had breast cancer (75.4 percent), 19 had hematologic cancers (10.2 percent), 14 had endometrial or cervical cancers (7.5 percent), and 13 had other cancers (6.9 percent). The study found that oncofertility patients produced a comparable amount of oocytes to noncancer patients. However, the ratio of mature oocytes to total number of oocytes retrieved was lower among cancer patients than those without cancer.

“Clinicians should counsel patients that while outcomes may not be identical in patients with cancer, fertility preservation with oocyte freezing can result in a satisfactory yield of mature oocytes for future use,” the study said.

For patients who later undergo in vitro fertilization, genetic testing is an increasingly important tool, Dr. Copperman says. A standard part of in vitro is testing for chromosomal abnormalities in embryos prior to implantation. For patients with known cancer-causing mutations, testing the embryos for BRCA1 and BRCA2 genes or Lynch syndrome mutations is now commonplace. Depending on family history, genetic testing can look at a wide array of cancers for which the relevant genetic mutations are known. “This represents a paradigm shift from disease treatment to disease prevention,” Dr. Copperman says. Families that have been carrying mutated genes from one generation to the next can, instead, produce children who do not carry the same genetic risk of cancer.

Both cancer and its treatment can detrimentally affect fertility. Chemotherapy can lead to growth hormone deficiency, hypothyroidism, or pubertal abnormalities. Radiation therapy applied to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Hormone therapy can disrupt the menstrual cycle, thus affecting fertility. And surgery can involve removing reproductive organs or can lead to scarring that decreases fertility. This is true for male, female, and gender-nonconforming patients. At Mount Sinai, efforts are underway to look at fertility preservation for adolescents, as well.

“With fertility preserved, patients can come back cured of the disease. They can use their embryos, and they end up having babies,” Dr. Copperman says. “And that's the story of hope. Meaningful survivorship often begins with preemptive counseling and timely and targeted treatment.”

For a referral or more information, go to Oncofertility Services at Mount Sinai.