Fertility pre­ser­va­tion

Fertility pro­tec­tion

Currently, four different options exist for fertility pre­ser­va­tion prior to gon­ado­tox­ic therapy. These are listed below:

Down­reg­u­la­tion of the ovaries during chemo­ther­apy with a so-called GnRH agonist.

  • Low incon­veni­ence and imme­di­ately feasible (e.g., as a monthly or 3‑monthly injection)
  • not recom­men­ded as a sole method for fertility pre­ser­va­tion due to incon­sist­ent study data on effectiveness
  • Possible applic­a­tion in com­bin­a­tion with cryo­p­reser­va­tion of oocytes and/or ovarian tissue, depending on time available before cytotoxic therapy is administered


Germany: Self-pay service
Switzer­land: Self-pay service
Austria: Self-pay service

Har­vest­ing of oocytes after ovarian stimulation

  • Required time frame at least 14 days, multiple pro­ced­ures are possible depending on the time available and, depending on the indi­vidu­al oocyte reserve, this may also be advisable.
  • chances depend on age, number of retrieved mature oocytes and under­ly­ing disease
  • later ICSI necessary
  • later follow-up costs in terms of co-payment analogous to other MAR (medical assisted repro­duc­tion) depending on insurance status
  • later embryo transfer also possible if no ovarian activity is left


Germany: Costs (including storage costs) are covered since 01.07.2021 after pub­lic­a­tion of the first cryo­p­reser­va­tion guideline by the G‑BA (Joint Federal Committee), provided that the con­di­tions for coverage are met (possibly billing problems at the universities)
Switzer­land: Cost coverage incl. storage costs for 10 years.
Austria: In case of an existing part­ner­ship, 70% cost coverage by the IVF fund is possible, provided that the con­di­tions for coverage are met,
storage as a self-payer service.

Freezing of ovarian tissue

  • can be carried out at very short notice, time required is approx. 2 days
  • spon­tan­eous preg­nan­cies and res­tor­a­tion of natural ovarian activity is possible
  • only option for pre­serving fertility in children and adolescents
  • Risk of trans­fer­ring malignant cells during sub­sequent trans­plant­a­tion (depends on tumor type)


Germany: Cost coverage planned by the G‑BA for women after menarche until 40. birthday, currently still a self-pay service, currently positive indi­vidu­al case decisions by health insurance companies possible
Switzer­land: Cost coverage incl. storage costs for 10 years.
Austria: Self-payer benefit.

Surgical relo­ca­tion of the ovaries from the radiation area

  • useful in case of sole radiation of the ovaries
  • scattered radiation at high dose despite ovarian relo­ca­tion may reduce fertility
  • possibly restric­tion of fertility after co-irra­di­ation of the uterus
  • surgical inter­ven­tion required for sub­sequent relo­ca­tion of the ovaries to archive spon­tan­eous pregnancy
  • not recom­men­ded as the sole method of fertility preservation
  • possible in com­bin­a­tion with cryo­p­reser­va­tion of oocytes and/or ovarian tissue, depending on time available before cytotoxic therapy


Germany: Self-pay service (if no other abdominal surgery is  required).
Switzer­land: Cost coverage
Austria: Cost coverage

Measures after chemotherapy:

Even after chemo­ther­apy and/or radiation, fertility-pre­serving measures may still be possible. We therefore recommend coun­sel­ing in this situation as well. Another important topic of dis­cus­sion after therapy can be endo­crino­lo­gic­al (= hormonal) aftercare.

All these pro­ced­ures can be combined with each other — if reas­on­able and desired.

One way to facil­it­ate the patient’s decision after the con­sulta­tion regarding fertility pre­serving measures is the “decision aid” online tool  “linked here”.

It is a digital decision aid developed by psy­cho­lo­gists, psy­cho­ther­ap­ists and repro­duct­ive physicians.

Detailed inform­a­tion and a bib­li­o­graphy can be found in the Fer­ti­PRO­TEKT booklet “Indika­tion und Durch­führung fer­til­ität­s­pro­tekt­iver Maßnahmen bei onko­lo­gis­chen und nicht-onko­lo­gis­chen Erkrankun­gen”, 2nd revised edition 2020, which was written by members of the Fer­ti­PRO­TEKT Netzwerk e.V. and is available free of charge (in German).

(Chap. 3) (german version)

An english version can be bought: Fertility Pre­ser­va­tion in Onco­lo­gic­al and Non-Onco­lo­gic­al Diseases a practical guide by Michael von Wolff & Frank Nawroth ISBN 978–3‑030–47567‑3 from Springer.com

Part III page 169ff.