For women, studies  have shown that movement of the ovaries out of the field of radiation (ovariopexy)—laterally, toward the iliac crest, or behind the uterus—may help preserve fertility when high doses of radiation therapy are being applied. By relocating the ovaries laterally it is possible to shield them during radiation of the para-aortic and femoral lymph nodes. Pelvic radiation, however, still provokes an irradiation of the ovary of 5% to 10%, even if transposed outside the irradiation area. Similar prevention strategies are available for men. When possible, lead shields are used to protect the testes.
When feasible and relative to the necessity of treatment, oncology professionals should discuss reproductive cell and tissue banking with patients, referring to a reproductive endocrinologist before chemotherapy and/or radiation. Men can store sperm from semen ejaculate, epididymal aspirate, testicular aspirate, and testicular biopsy.[19,20,21,22] Women can store ovarian tissue, ovarian follicles, and embryos.[23,24][Level of evidence: II] In oocyte cryopreservation, which is still experimental, reproductive cells/tissue are cryopreserved for future use in artificial insemination for patients who wish to protect their reproductive capacity. One published case report describes a live birth after in vitro fertilization of thawed cryopreserved ovarian cortical tissue into the ovaries of a 28-year-old woman who experienced ovarian failure secondary to high-dose chemotherapy for non-Hodgkin lymphoma.[Level of evidence: III] For this case, ovarian tissue (containing many primordial follicles) was harvested after administration of a second-line conventional therapy regimen and before treatment with high-dose chemotherapy. Since this time, work has continued to advance technology related to the preservation of unfertilized eggs and ovarian tissue cryopreservation. More data have been published from clinics using preservation of unfertilized eggs, an important option for unpartnered, fertile women at the time of cancer diagnosis and treatment. The New York University (NYU) Fertility Center reported an ongoing/delivered pregnancy rate of 57% using oocyte cryopreservation. The authors state that this rate is better than the U.S. rate for conventional in vitro fertilization using fresh (as opposed to cryopreserved) oocytes. They also report that this success rate was similar to that for age-matched controls who underwent conventional in vitro fertilization at the NYU Fertility Center. There is likely a good deal of variability in the expertise and success rates of fertility centers using these newer strategies. When options for patients are being investigated, critical review is needed.
These options may not be appropriate for all patients. Counseling is an important part of the decision-making process for patients. Thinking through these decisions at a time when patients are struggling with issues of life and potential death are often difficult. Patients need to consider costs, stress, time, emotions, and potential inclusion of another individual in the pregnancy process (i.e., a surrogate). For many patients, the financial costs associated with in vitro fertilization and subsequent embryo cryopreservation is cost prohibitive. Consideration also needs to be given to the current rate of failure for in vitro fertilization procedures and the potential adverse effect of malignancy on sperm parameters.[Level of evidence: III] A retrospective analysis, with a limited sample size, reported that the oocytes from patients with malignant disorders were of a poorer quality and exhibited a significantly impaired fertilization rate compared with age-matched controls. Importantly, data on the outcome of pregnancies in cancer survivors [Level of evidence: III] have not shown any increase in genetically mediated birth defects, birth-weight effects, and sex ratios. Based on the evidence thus far, individuals treated with cytotoxic chemotherapy who remain fertile are not at an increased risk of having children with genetic abnormalities. For all patients who wish to be parents and who have permanent infertility, adoption should be presented as a choice.