Fertility preservation is considered for individuals who are starting treatment for potentially life-limiting diseases and where the treatment may negatively impact their future ability to have children.

It also includes people who want to wait to have children for other reasons. This may include members of the armed forces, transgender people or those considering gender reassignment surgery.

Preserving fertility in women is more complex than in men, as it involves retrieving and storing eggs or embryos.

Common methods include:

Egg freezing or cryopreservation: When unfertilised eggs are ‘vitrified’ and stored.

Embryo freezing/embryo cryopreservation: The most common and successful option for preserving a woman’s fertility. Conventional slow freezing or vitrification can be applied.

Ovarian transposition: Minor surgery to move the ovaries from the area that will receive radiation.

Ovarian reproductive material freezing: An effective method of enabling a successful pregnancy in women who have had oncology treatment. It is also the only option for younger girls who have not started ovulating. However, this carries a risk of xenotransplantation (re-introduction of cancer cells).

During a natural menstrual cycle, only one egg is typically produced. Fertility treatment involves daily injections of follicle-stimulating hormone for 10–14 days to stimulate multiple egg production.

Egg retrieval is usually carried out under conscious sedation or general anaesthesia. Eggs may be frozen or fertilised with sperm. Risks, though rare, include bleeding, infection and organ injury.

In the UK, there is no legal age limit for egg freezing. However, NHS clinics usually set a cut-off age of 45 and look at each request case by case.

• Counselling and consent: Required for informed decision-making.
• Physical demands: Egg collection is more intensive than sperm collection.
• Storage limits: Understanding duration and renewal requirements.
• Treatment realities: Success depends on current technology and individual factors.
• Timeframes and costs: Treatment, storage and renewal fees apply.
• Legal updates: Gametes can be stored for up to 55 years with consent every 10 years.

Sperm freezing, or cryopreservation, is the best way to preserve male fertility. The samples are treated with a cryopreservation media; the specimen is placed in vials or straws and suspended in liquid nitrogen.

• Sperm quality, collection methods and genetic risks—especially after chemotherapy—should be discussed.
• Young boys and unwell men may struggle with collection, requiring alternative methods like electro-ejaculation or surgical retrieval (rather than masturbation and ejaculation).

You can discard stored samples if you restore fertility or donate them for research. Advancements include freezing reproductive tissue from young cancer patients for future use.

Discussing fertility preservation with children and teenagers requires a different approach. Many young patients may not fully understand the long-term consequences of their treatment.

Key considerations for young patients:

• Timing: Is there enough time to undergo fertility preservation before starting treatment? Does life-saving treatment need to take precedence?
• Emotional impact: Fertility discussions can be distressing. This is especially true if a child has a serious illness.
• Ethical/cultural/religious issues: Parents may have to make decisions on behalf of their child, which can be challenging.
• Counselling: Specialist fertility counselling should be offered to both the young person and their family.

When taking consent for storage, all scenarios (including posthumous use) should be discussed. Patients should also be provided with information about the maximum storage period for which they can consent.

• For girls who have not begun ovulating, ovarian tissue cryopreservation is the only viable method.
• For prepubescent boys, testicular tissue cryopreservation, though still considered experimental, is the only alternative to electro-ejaculation or surgical sperm retrieval.

Fertility preservation is governed by strict regulations in the UK. Key legislation includes:

• HFEA Code of Practice (2023), Edition 10: Provides detailed guidance for licensed fertility clinics on compliance with the Human Fertilisation and Embryology Act, including patient consent, storage limits and posthumous use of gametes.
• The Human Fertilisation and Embryology Act (1990): Outlines the legal requirements for the storage and use of reproductive materials such as eggs, sperm and embryos.
• The Human Tissue Act (2004): Regulates the collection, storage and use of human tissue, including ovarian and testicular tissue for fertility preservation.
• The 2022 legal update: Extended the maximum storage period for gametes and embryos from 10 to 55 years, with renewed patient consent required every 10 years. This allows greater flexibility for individuals preserving fertility for medical or personal reasons.

Additionally, posthumous use of gametes is only permitted if the deceased person provided explicit written consent. Without this, stored reproductive materials must be destroyed.

Nurses play an essential role in ensuring that patients receive accurate, timely and supportive guidance about fertility preservation.

There are two distinct areas for increasing knowledge and understanding among nurses:

1. Those who require general information to refer for specialist care.
2. Nurses working in fertility services who have roles in fertility preservation. Nurses also need to be aware of the availability of services locally.

• Providing clear information about fertility risks and preservation options.
• Ensuring patients are aware of their legal rights and responsibilities, including ongoing consent requirements.
• Referring patients to fertility specialists as early as possible, particularly before medical treatments that could impact fertility.
• Supporting patients emotionally—fertility concerns can add to the stress of a serious diagnosis.
• Understanding funding options—NHS coverage for fertility preservation varies depending on medical conditions and location.

Nurses who do not specialise in fertility services should be prepared to have initial discussions and direct patients to appropriate resources and services.

Those working in fertility clinics need a deeper understanding of the legal, medical and ethical frameworks surrounding fertility preservation.

Advances in technology have made fertility preservation more effective and accessible, but challenges remain in ensuring equal access, ethical considerations and patient awareness. 

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.