Fertility Preservation - Fight Colorectal Cancer

Fertility Preservation

If you have been diagnosed with colon or rectal cancer, ask how treatment could affect your ability to have biological children. This conversation matters even if you are unsure about having children or already have children.

Here’s why. Some cancer treatments can affect fertility temporarily or permanently. Your risk depends on your treatment, age, and reproductive health. Fertility preservation may help protect your options, and many approaches are best considered before treatment begins. 

You do not need to know whether you want children before asking about your options. Your care team can help you understand the choices and how much time you have to decide. 

This page covers: 

  • How treatment can affect your fertility 
  • What you can do to protect it 
  • Questions to discuss with your care team and anyone you want involved in your decisions

You have more say in this than it may feel like. Ask questions early.

Why fertility matters with young-onset colorectal cancer 

Colorectal cancer treatment may include surgery, chemotherapy, radiation, or other medicines. Each can affect fertility differently. Your individual risk depends on the specific treatments you receive, rather than your age or diagnosis alone. 

Colorectal cancer is different from many cancers in one keyway. The colon and rectum are near reproductive organs, surgery and pelvic radiation can affect these structures. Chemotherapy travels throughout the body, so it can affect fertility even when reproductive organs are outside the treatment area. 

Here is how each type of treatment can affect fertility:

  • Radiation: Rectal cancer is often treated with radiation to the pelvis. The ovaries and testicles are very sensitive to radiation, even at low doses, so this can damage them. How much damage depends on the size of the radiation field, the dose, and the number of treatments. In people with ovaries, it can cause early menopause. 
  • Radiation and the uterus: Radiation can damage the uterus and affect the ability to carry a pregnancy. This can matter even if eggs or embryos were frozen before treatment. 
  • Chemotherapy: The chemo used for colorectal cancer can harm eggs and sperm, although at much lower rates than radiation. Some targeted therapies can affect fertility too, so ask your doctor whether any of your specific treatments have been linked to fertility side effects. 
  • Surgery: Surgery in the pelvis can affect fertility. Removing the uterus or both ovaries causes infertility directly. Other surgery in this area can cause scarring or nerve damage that makes it harder to conceive or affects sex. 

What “fertility preservation” means 

Fertility preservation means saving or protecting your eggs, sperm, embryos, or reproductive tissue. These approaches may help you have biological children in the future, but they do not guarantee pregnancy or birth. 

Two things make timing important: 

  1. Many options are best completed before treatment begins. If you have already started or finished treatment, ask for a referral anyway. You may still have options.
  2. Your team can coordinate the timing. Egg or embryo freezing often takes about 2 to 3 weeks, and stimulation can usually begin without waiting for your next period. Sperm banking may be possible within a few days. Your oncology and fertility teams will determine what can be done safely within your treatment schedule. And for rectal cancer, moving the ovaries out of the way can be part of your surgery.

The American Society of Clinical Oncology (ASCO) sets national guidelines for cancer care. ASCO says doctors should talk about fertility with young patients as early as possible, before treatment. People who are interested in fertility preservation, or unsure about it, should be referred to a reproductive specialist. 

Here is something worth knowing. Just having the talk helps. Patients who talk about fertility feel less stress later. This is true even if they do not end up saving eggs or sperm. 

So if your team has not brought it up, you can. It is a fair thing to ask. And ASCO says this talk should keep going after treatment too, not just at the start. 

Your options to protect your fertility 

The right option depends on your body, your age, and how much time you have. Here are the main choices.  

If you make sperm 

  • Sperm banking: This is the top choice. It is safe and simple. It has helped many people have babies. ASCO says people who make sperm should be offered this before treatment. More samples give you more choices later, but even one sample can work. Frozen sperm can later be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). 
  • Surgical sperm removal (TESE): If you cannot provide a semen sample or no sperm are found in the sample, a specialist may be able to retrieve sperm directly from the testicle.

One warning: sperm collected after treatment starts has a higher risk of gene damage. That is the main reason to bank sperm first. 

If you have ovaries and a uterus 

  • Egg freezing: Medicines stimulate the ovaries, and eggs are collected during a procedure and froze without being fertilized. This option does not require choosing a sperm source now. A cycle often takes about 2 to 3 weeks. 
  • Embryo freezing: Collected eggs are fertilized with sperm from a partner or donor, and the resulting embryos are frozen. Before starting, discuss the consent forms and who will have decision-making rights over the embryos. 
  • Ovarian tissue cryopreservation (ovarian tissue freezing): A doctor removes and freezes ovarian tissue. It can be put back later. This does not need a delay, so it can be done fast. It is no longer considered experimental, but it is not widely available and should be done at an experienced center. 
  • Ovarian transposition (moving the ovaries): A doctor moves your ovaries up and out of the radiation area. This matters most for rectal and anal cancer. It does not always work, as some radiation can still reach the ovaries. It works best when done close to your radiation. Ask your doctor if it fits your case. 
  • Hormone shots (GnRH agonists): ASCO says this should not replace proven methods like freezing eggs, embryos, or tissue. It may help in some cases, but it is not a substitute. 

Newer options 

In vitro maturation (IVM) involves collecting immature eggs and maturing them in a laboratory. It is an emerging option available at some specialist centers. Uterine transposition, surgery to move the uterus away from pelvic radiation, remains experimental. 

Ask your specialist about your chance of success, the number of eggs or sperm samples that may be needed, and the costs of using them later. Success depends on several factors, including age at egg collection and the amount of material stored. 

How do I find a fertility specialist? 

Ask your oncology team for an urgent referral to a fertility specialist experienced in caring for people with cancer. Depending on your needs, this may be a reproductive endocrinologist or a reproductive urologist. If not, the Society for Assisted Reproductive Technology (SART) has a “Find a Clinic” database you can search by location. 

Let the clinic know you’re a cancer patient who needs to be seen urgently, so they can evaluate you well before you start treatment. 

FIND A CLINIC

What to talk about with your partner and care team 

This part is easy to skip, but important! Before storing eggs, sperm, tissue, or embryos, ask about consent forms, future use, and storage costs. Include a partner or other support person if you want them to be involved. 

Who decides what happens to embryos? 

Decision-making rights over stored embryos depend on the circumstances, consent agreements, clinic policies, and applicable law. Ask who must agree before embryos can be used and what happens if circumstances change.  

Deciding what to do with existing embryos can get hard in those moments. It can even go to court. ASCO says patients should know this before they start. 

Freezing eggs instead of embryos avoids this question entirely, since the eggs are yours alone. For some people, that is reason enough to choose eggs. 

Ask yourselves: If things change, what do we each want done with the embryos? Put it in writing with the clinic. 

If something happens to you 

This is hard to think about, but important! Clinic forms should explain what happens to stored eggs, sperm, tissue, or embryos if you die or cannot be reached. You can document whether you want them to be used, donated where permitted, or discarded. 

Rules about use after death, legal parenthood, and inheritance vary by state. Ask your clinic whether you should speak with a lawyer experienced in reproductive law. 

Who pays to store it? 

Storage fees may continue for many years. Ask what is included, whether fees can increase, and what the clinic’s policy is if payments stop or it cannot reach you.

If the patient is a teen 

For teens, the law asks for two things. The teen must agree. And a parent or guardian must give consent. A treatment should not go ahead if the teen says no. Give the teen space to share what they want.

Cost and insurance, and how to fight a “no” 

Fertility preservation is not cheap. Coverage is uneven. But it is getting better. And you have more power than you may think. 

No federal law makes insurers cover it. But a growing number of states have laws that require some coverage. Whether your plan follows those laws depends on your plan type. Large employer plans often set their own rules and are not required to follow state laws. Your fertility clinic can check your benefits for you before you start. 

If you get a “no,” appeal it. Appeals often work. Here is what to know: 

  • Every insurer has an appeals process. Your denial letter should tell you how to file. 
  • Every state also has an outside appeals process. It is often called Independent Medical Review. Not many people use it. But those who do often get coverage. 
  • There is a fast-track option. It gives an answer within 72 hours. This helps when you are racing to decide before treatment. 
  • The best point to make: this is not “elective.” It is a needed step to prevent infertility caused by cancer. Your care team may help you make this case. 

Want a clear guide to costs, state laws, and appeals? Triage Cancer’s free Quick Guide to Fertility Preservation is a great, up-to-date resource: Triage Cancer — Quick Guide to Fertility Preservation

Questions to ask your care team 

Write these down before your next visit: 

  • Will my treatment affect my fertility? How much? 
  • Are there treatment options that would affect it less? 
  • If I need pelvic radiation, can you move my ovaries out of the way? 
  • What are my options to protect my fertility? What are the pros and cons? 
  • Can you send me to a fertility specialist? How soon? 
  • Will this delay my cancer treatment or make it work less well? 
  • What will it cost? Will my insurance cover it? 
  • What are the storage fees, and who is responsible for paying them? 

Where to get help 

  • LIVESTRONG Fertility — help becoming a parent after cancer, plus lower-cost services: livestrong.org 
  • Society for Assisted Reproductive Technology (SART) — search for a clinic near you: Find a Clinic 

The bottom line 

Ask your oncology team how treatment may affect your fertility and whether you can see a fertility specialist before treatment begins. You do not need to be certain about having children to ask for a referral. 

If treatment has already started, ask anyway. There may still be options. 

Fertility preservation is a personal choice. Your care team can help you weigh the benefits, costs, timing, and uncertainty so you can decide what is right for you. 

Sources:  

  • Su HI, Lacchetti C, Letourneau J, et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. Journal of Clinical Oncology. 2025;43(12):1488–1515. DOI: 10.1200/JCO-24-02782. Read it here. 
  • Triage Cancer — Quick Guide to Fertility Preservation. triagecancer.org/quick-guides/fertility-preservation 
  • Robertson JA. Cancer and Fertility: Ethical and Legal Challenges. Journal of the National Cancer Institute Monographs. 2005;(34):104–106. DOI: 10.1093/jncimonographs/lgi008. 
  • NCCN Guidelines for Patients: Colon Cancer / Rectal Cancer (2026). NCCN.org/patientguidelines