After receiving a cancer diagnosis, patients often have a little time to process what is happening. Investigations, staging, treatment planning, and a treatment start date tend to follow almost immediately. Understandably, the patient’s entire attention is focused on surviving the disease.Yet for younger patients, there is another important issue that may need to be addressed before treatment begins: fertility preservation.A person who has only just learned they have cancer may, in the same breath, be asked whether they want to preserve the possibility of having a biological child in the future. It’s a difficult question to face particularly when the patient’s immediate priority is simply getting through the diagnosis and the treatment ahead.But time matters here. Once certain cancer treatments begin, the possibility of preserving fertility may be significantly reduced or lost altogether. This is why fertility preservation has become an important part of cancer care, and why oncofertility – a field at the intersection of oncology and reproductive medicine has emerged.
Why Can Cancer Treatment Affect Fertility?
The goal of cancer treatment is to destroy malignant cells. Unfortunately, some treatments can damage healthy tissue along the way.The risk is particularly significant with certain types of chemotherapy, radiation therapy, surgery involving the reproductive organs, and the intensive conditioning regimens used before hematopoietic stem cell transplantation.In women, such treatment may reduce ovarian reserve, impair ovarian function, and lead to premature menopause. In some cases, it can also affect the uterus, making a future pregnancy more difficult to carry.In men, treatment may damage sperm production. In some patients this recovers after treatment; in others, the damage may be permanent.The picture is more complex still in children. Before puberty, girls do not yet have mature oocytes and boys do not yet produce mature sperm, so fertility preservation options for prepubertal patients differ considerably from those available to adults.
The Medical Options Are Expanding
Fertility preservation options have expanded considerably in recent years. The American Society of Clinical Oncology (ASCO) has issued recommendations on fertility preservation since 2006, updated in 2013 and 2018, with a further update in 2025 that broadened the guidance on fertility risk assessment, counseling, and preservation options.The 2025 ASCO guideline update also addresses newer approaches, including in vitro maturation (IVM) of oocytes, which may offer an additional option for selected patients (1).The central principle is straightforward: the potential impact of cancer treatment on fertility should be discussed with an appropriate patient before treatment begins. This responsibility doesn’t rest with reproductive specialists alone , depending on the clinical situation, the conversation may need to be initiated by an oncologist, hematologist, surgeon, radiation oncologist, or, in children, a pediatric oncologist.Yet the reality on the ground is more complicated.A systematic review by Algave, Beauchemin, and colleagues found that the proportion of patients who had a documented or reported discussion about fertility preservation ranged from 9% to 75% across studies. Referral to a fertility specialist ranged from 0.9% to 57%, while the proportion of patients who ultimately underwent a fertility preservation procedure ranged from 0.56% to 70.3% (2).In other words, the problem isn’t simply that the available methods are expensive, invasive, or time-consuming. Often, it starts much earlier: the patient may not know that an option exists at all.
What Options Are Available Today?
For Men
For postpubertal males, sperm cryopreservation is the most established and straightforward fertility preservation method. In many cases, a semen sample can be collected and cryopreserved within a short window before treatment begins. If a patient is unable to provide a sample, sperm can also be retrieved surgically from testicular tissue.
For Women
For women, the most established options are oocyte and embryo cryopreservation. In the past, ovarian stimulation was closely tied to a particular phase of the menstrual cycle, which could sometimes delay the start of cancer treatment. Today, so-called random-start protocols allow ovarian stimulation to begin at almost any point in the cycle, meaning the process can often be completed within roughly 10-14 days.For some patients, ovarian tissue cryopreservation (OTC) is another option -particularly valuable when there isn’t enough time for hormonal stimulation, or when treatment needs to begin very quickly. OTC has evolved considerably in recent years and is no longer regarded as purely experimental.
For Children
For prepubertal children, the available options are more limited. For girls, ovarian tissue cryopreservation may be considered; for boys, testicular tissue cryopreservation may offer a path to future fertility. This field continues to evolve, and the approaches involved are more complex in children -but for patients who have no other option, their availability can matter enormously.
What Does This Mean for Georgia?
At this point, the issue is no longer only about what modern medicine can offer. It’s also about access.Based on currently available information, cryopreservation of germ cells and reproductive tissue for oncology patients is offered at a single reproductive health center in Georgia. The center itself describes its service as the only one of its kind in the country.On one hand, this is a meaningful development -he service exists. On the other, it raises several practical questions.
Does the Patient Know the Option Exists?
If a doctor doesn’t raise the issue after a cancer diagnosis, the patient may never learn that fertility preservation is something they can consider. International research has repeatedly shown that these discussions don’t happen consistently, and are sometimes initiated by the patient rather than the treating physician.A 2009 study by Quinn and colleagues, published in the Journal of Clinical Oncology, found that only 47% of oncologists reported routinely referring patients to reproductive specialists (3). A 2011 study by Arafa and Rabah in pediatric oncology similarly found gaps in physicians’ familiarity with the relevant fertility preservation recommendations (4). More recent research published in the Journal of Cancer Survivorship in 2025 points to a related root cause: a lack of specific training in oncofertility among oncology professionals (5).Patients’ own experiences reflect the same gap. According to a review published in the ASCO Post, only about half of reproductive-age patients recalled discussing fertility with their care team at the time of diagnosis (6). This becomes especially significant when a decision may need to be made within a few weeks-or sometimes within only a few days.
What Does This Mean for Patients Living Outside Tbilisi?
A cancer diagnosis already leaves a patient with countless decisions to make.
Now picture a patient living in one of Georgia’s regions, whose treatment is due to begin within days. Before it starts, they may need to travel to Tbilisi, consult a reproductive specialist, undergo the necessary investigations, and complete the appropriate procedure all while still processing the diagnosis and preparing for treatment. They may also need to arrange accommodation and cover significant additional expenses.In practice, such a patient may not be choosing not to pursue fertility preservation, they may simply be unable to exercise the choice available to them. This is no longer only a medical issue; it’s a question of accessibility and equity.
And the Most Practical Question: Who Pays?
The cost of oocyte or embryo cryopreservation can be substantial. Beyond the procedure itself, patients may face expenses related to medication, consultations, follow-up visits, and annual storage fees.In some countries, legislation now requires insurance coverage for fertility preservation when it is medically necessitated by cancer treatment. In Georgia, it’s worth establishing how financially accessible these services actually are for patients, and whether any state or insurance mechanisms exist to help cover them, because the existence of a technology isn’t enough on its own. If a patient can’t afford to use it, the choice exists only on paper.
Informed Patient Choice
During cancer treatment, fertility preservation may initially seem like a secondary concern. A patient may not want to think about having children at that moment. They may already have children. They may not know whether they’ll ever want children. Or they may simply be unable to hold that decision in mind on the day they receive a cancer diagnosis.That’s precisely why the physician’s role matters so much here to provide clear, relevant information about an option that may be available today but may no longer be available once treatment begins. That is what informed choice looks like.Ultimately, the goal of modern cancer care shouldn’t be limited to extending a patient’s life. If medicine can save someone’s life, it should also consider what that life may look like afterward. The possibility of having children isn’t equally important to everyone, but everyone should have the opportunity to make that decision for themselves.
For this reason, fertility preservation should become an integral part of the pre-treatment oncology pathway- not an additional service available only to patients who happen to learn about it or know to ask. Patients of appropriate age and risk should receive this information early enough to make a meaningful decision.Georgia already has services in this field. The next step is ensuring that patients know these services exist, that clinicians recognize when and how to raise the conversation, and that the healthcare system can make fertility preservation genuinely accessible to those who need it.
Author: Anna Jghamadze, MD, Radiation Oncology Resident
