Oncofertility Guide: How to Preserve Fertility in the First 48 Hours After a Cancer Diagnosis

The moment a person hears the word “cancer,” their world often narrows to a single objective: survival. However, as oncology treatments have become more effective, a secondary but vital conversation has emerged regarding the quality of life after cancer. For many patients of reproductive age, that quality of life includes the dream of biological parenthood.

What is Oncofertility and Why Does it Matter?

This intersection of oncology and reproductive medicine is known as oncofertility. It is a specialized field dedicated to providing fertility preservation options to people whose reproductive health may be impacted by cancer treatments, such as chemotherapy, radiation, or surgery.

Dr. Kara Kelly, who serves as chair of the Department of Pediatric Oncology, as well as the Waldemar J. Kaminski Endowed Chair of Pediatrics at Roswell Park Comprehensive Cancer in Buffalo, New York, echoed in an interview with CURE that select chemotherapy agents are linked with an impact on chemotherapy.

“Our female survivors are at higher risk for developing premature menopause, while male survivors are at risk for not being able to produce sperm anymore,” Kelly explained. “Therefore, it is very important that our survivors have an oncofertility consultation at the time of diagnosis, so they know what their options are, especially regarding the cryopreservation of eggs or sperm, to give them more options after their therapy is complete.”

Why the First 48 Hours Are Critical for Fertility Preservation

The window for fertility preservation is often narrow. Because many cancer treatments must begin as soon as possible, the first 48 hours following a diagnosis are the most critical for decision-making. This guide provides a roadmap for navigating those first two days to ensure that tomorrow’s dreams are protected during today’s fight.

A Step-by-Step Timeline for Newly Diagnosed Patients With Cancer

Hours 1–12: Initiating the Fertility Conversation

The most important step happens in the oncologist's office the moment a treatment plan is discussed. Patients should not wait for their medical team to bring up fertility. While many oncologists are proactive, some may be focused entirely on the immediate pathology of the tumor.

Action Item: Ask the "Day Zero" question: "Will this treatment affect my ability to have children in the future, and can I see a fertility specialist before we begin?"

If the answer to the fertility question is "yes" or "maybe," the next step is an immediate referral to a Reproductive Endocrinologist (REI) who specializes in oncofertility. Standard fertility clinics may have waiting lists that span months; however, oncofertility cases are treated as medical emergencies.

The Action Item: Ensure the oncology nurse or navigator marks the referral as "urgent" or "urgent oncofertility." The goal is to have a consultation scheduled within 24 to 72 hours.

In a cross-sectional study, researchers evaluated the predictors of fertility preservation referrals from oncologists to REI physicians.² In the study, 510 patients who were aged between 14 and 42 years, seen by an oncologist from 2022 and 2024 with a new cancer diagnosis, and had planned treatment that was either gonadotoxic or required delayed pregnancy, investigators assessed the referral rates to REI physicians. Findings showed that 22.5% of these patients were referred to fertility preservation, and patients older than 30 years were less likely to be referred than younger. Additionally, patients with breast cancer were most likely to be referred vs those with other types of cancer.

“Standardizing [fertility preservation] referrals across oncology specialties, consideration of electronic health record ‘soft stops’ for referral and increasing patient and provider education are essential to improving referral rates,” the researchers wrote in their study, which was published in the Journal of Assisted Reproduction and Genetics.

Hours 12–24: Securing an Urgent Specialist Referral

Fertility preservation can be expensive, and insurance coverage varies significantly by state and provider. However, the first 24 hours is the time to gather resources. Many organizations provide "heartbeat" grants or discounted medications for patients with cancer.

The Action Item: Contact your insurance provider to ask if your policy covers "iatrogenic infertility,” which is infertility caused by medical intervention. Additionally, look into organizations like Livestrong Fertility or The Chick Mission, which offer financial assistance specifically for this window.

Hours 24–48: Understanding Your Preservation Options and Costs

By the second day, the patient should ideally be meeting with an REI. This meeting is not about starting a family today; it is about "banking" options. For women, this may involve discussing egg or embryo freezing, which typically requires a 10- to 14-day cycle of hormone injections. For men, this involves sperm banking, which can often be completed in a single day.

The Action Item: Discuss the timeline with the REI. They must coordinate closely with the oncologist to ensure that a two-week delay for egg harvesting will not compromise the cancer prognosis.

Essential Questions to Ask Your Oncology Team About Fertility and Next Steps

To bridge the gap between oncology and fertility, use these specific questions to prompt detailed answers from your medical team:

• To Your Oncologist: "What is the gonadotoxicity level of this specific chemotherapy regimen? Is there a less toxic alternative that is just as effective for my type of cancer?"
• To Your Oncologist: "Can we delay treatment by two weeks for an egg retrieval cycle, or do I need to start treatment immediately?"
• To Your Fertility Specialist: "Based on my age and diagnosis, what is the likelihood of successful egg/sperm retrieval in the time we have available?"
• To Your Fertility Specialist: "What are the long-term storage costs for my genetic material?"

The 48-hour window is intense, but it is often the only opportunity to act. Once chemotherapy or pelvic radiation begins, the damage to oocytes — eggs — or sperm-producing cells can be irreversible.

Patients should remember that they are their own best advocates. If a medical team seems dismissive of fertility concerns, it is within the patient’s rights to seek a second opinion or contact a dedicated oncofertility navigator. Preservation is not a distraction from cancer treatment; it is a vital component of a comprehensive survivorship plan.

Reference

1. CURE, “Navigating Lymphoma and Survivorship in Adolescents and Young Adults.” CURE. May 8, 2025. https://www.curetoday.com/view/navigating-lymphoma-and-survivorship-in-adolescents-and-young-adults
2. Chey PN. “Predictors of referral for fertility preservation counseling in patients diagnosed with cancer.” The Journal of Assisted Reproduction and Genetics. January 2, 2026. https://pubmed.ncbi.nlm.nih.gov/41483126/

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

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