Fertility & IVF
Fertility Preservation Before Cancer Treatment: Options and NY Coverage
Fertility preservation means freezing eggs, embryos, sperm or reproductive tissue before a treatment that could damage fertility, such as chemotherapy, pelvic radiation or surgery on the reproductive organs. ASCO and ASRM recommend that everyone of reproductive age facing these treatments be told about the risk and referred to a fertility specialist as early as possible. Since January 1, 2020, New York has required most insured health plans to cover medically necessary fertility preservation.
If you've just been diagnosed, you're probably in a blur of scans and appointments, and future kids may feel like the last thing you're allowed to think about. You're allowed. Your care team expects the question, and the window to act is short.
What to do this week
- Ask your oncologist directly: "Will my treatment affect my fertility, and can I see a fertility specialist before I start?"
- Ask for an urgent referral to a reproductive endocrinologist. Many hospital-based cancer centers have fast-track oncofertility consults.
- Call your insurer (or have the clinic's financial counselor call) to start prior authorization.
- Ask both doctors to talk to each other about timing, so you're not the go-between.
How much time does it take?
Many options can be done in about two weeks or less, and modern protocols often avoid long delays in cancer care. Sperm banking can often be done within days.
Random-start stimulation
Egg freezing used to start only at the beginning of a menstrual cycle, which could mean waiting weeks. Today many clinics use random-start protocols, beginning stimulation on any day of the cycle. That can save weeks.
Is it safe to delay treatment for egg freezing?
Most egg freezing cycles take about two weeks, and many can start right away. For many cancers, that short window doesn't change outcomes, but every case is different, and your oncologist decides whether any delay is safe. When there's no time at all, ovarian tissue freezing or GnRH agonists may be discussed.
Which treatments affect fertility?
- Chemotherapy, especially alkylating agents such as cyclophosphamide, at higher doses
- Radiation to the pelvis, abdomen or brain (affecting the pituitary)
- Surgery that removes or damages the ovaries, uterus or testicles
- Bone marrow or stem cell transplant conditioning
- Some hormone therapies that require years of delay before pregnancy
Risk depends on the drugs, doses, your age and your ovarian reserve before treatment. Some treatments carry high risk and others low risk. Your oncology team can estimate yours.
Options for people with ovaries
| Option | How it works | Time needed | Notes |
|---|---|---|---|
| Egg freezing | Hormone injections, then egg retrieval and freezing | About 2 weeks | No partner or donor sperm needed |
| Embryo freezing | Same as egg freezing, then eggs fertilized before freezing | About 2 weeks | Requires partner or donor sperm |
| Ovarian tissue freezing | Surgery to remove and freeze ovarian tissue | Can be done quickly | ASRM no longer considers it experimental; option for children and when stimulation isn't possible |
| Ovarian transposition | Surgery to move ovaries out of the radiation field | Before radiation | Used with pelvic radiation |
| GnRH agonist injections | Medicine to temporarily suppress the ovaries during chemo | During chemo | May help protect ovarian function in some cases; not a substitute for freezing eggs or embryos |
| Fertility-sparing surgery | Treatment that preserves the uterus or an ovary when safe | Varies | For selected early-stage gynecologic cancers |
What an egg-freezing cycle is like
You give yourself hormone injections, usually in the belly, for roughly 10 to 12 days. Most people are nervous about the needles and find them easier than expected after the first night; the clinic nurse will walk you through it. You'll have frequent early-morning monitoring visits for blood work and vaginal ultrasounds, often every day or two near the end. If you're commuting into Manhattan from Long Island or the Hudson Valley for this, ask whether some monitoring can be done at a satellite office closer to home. Retrieval is a short procedure under sedation, and you'll need someone to take you home. Bloating and cramping for a few days afterward are common.
Hormone-sensitive cancers
For estrogen-sensitive breast cancer, clinics commonly add letrozole during stimulation to keep estrogen levels lower. Your oncologist and fertility specialist decide together whether this is safe for you. More on egg freezing.
Eggs or embryos?
Embryos require sperm from a partner or donor now. Eggs keep that decision open. Some people split the retrieval and freeze some of each. It's a personal choice, and a fertility counselor can help you think it through.
Options for people with testes
- Sperm banking is simple, effective and often done in a few visits. Ideally samples are collected before treatment starts, since even one round of chemotherapy can affect sperm.
- Testicular sperm extraction may be an option if no sperm is found in the ejaculate.
- Testicular tissue freezing is offered for prepubertal boys at some centers in research settings.
Children and teens
Children and adolescents with cancer may be able to preserve fertility through ovarian or testicular tissue freezing, or egg or sperm freezing after puberty. Pediatric oncology centers often have oncofertility programs. Ask your child's care team early, even if it feels too soon.
Does insurance cover it in New York?
Since January 1, 2020, New York has required comprehensive individual, small-group and large-group insured plans to cover medically necessary fertility preservation when a medical treatment may directly or indirectly cause infertility. According to DFS guidance:
- Covered services include collecting, freezing and storing eggs or sperm, plus the prescription drugs used to collect eggs.
- There's no age restriction and no annual or lifetime dollar limit for fertility preservation.
- The law sets no specific storage time limit, though insurers may review medical necessity.
- IVF isn't required as part of the fertility preservation benefit.
- Prior authorization and normal cost sharing may apply.
Self-funded employer plans, Medicaid and Medicare aren't subject to this state mandate. If your card says "self-funded" or "ASO," or you're not sure, ask HR. Hospital financial counselors often know charitable programs that help with costs. See our New York IVF insurance guide.
After treatment
Your oncologist will tell you how long to wait before trying to conceive. Options may include:
- Trying naturally, if fertility has recovered
- Using frozen eggs or embryos through IVF
- Reimplanting frozen ovarian tissue
- Using donor eggs or sperm, or a gestational carrier
Some people who didn't preserve fertility still have fertility afterward. A fertility specialist can test your ovarian reserve or semen and help you plan. Learn about AMH and ovarian reserve.
Questions to ask your care team
- How likely is my treatment to affect my fertility?
- How much time do I have before treatment must start?
- Which option is safest and fastest for me?
- Will my insurance cover it, and who handles prior authorization?
- How long can my eggs, embryos or sperm be stored, and what will storage cost later?
When to see a doctor
Ask for a fertility preservation referral as soon as possible if:
- You've been diagnosed with cancer and may want children in the future
- You need surgery on your ovaries, uterus or testicles
- You're starting a treatment such as high-dose chemotherapy for another condition
- You're starting gender-affirming hormone therapy
Find a reproductive endocrinologist in New York, or narrow it to fertility specialists in Manhattan. Many hospital-based cancer centers in Manhattan, the Bronx and Long Island coordinate fast-track oncofertility consultations.
Frequently asked questions
How quickly can fertility preservation be done before chemotherapy?
Egg or embryo freezing usually takes about two weeks, and many clinics can start stimulation on any day of the cycle. Sperm banking can often be done within days. Ask for a referral as soon as you are diagnosed.
Does chemotherapy always cause infertility?
No. The risk depends on the drugs, doses, radiation field, your age, and your ovarian reserve before treatment. Some treatments carry high risk and others low risk. Your oncology team can estimate your risk.
Does New York insurance cover fertility preservation?
Yes, for most insured plans. Since January 1, 2020, New York has required comprehensive individual, small-group and large-group insured plans to cover medically necessary fertility preservation when treatment may cause infertility.
Is egg freezing safe with breast cancer?
Many people with hormone-sensitive breast cancer freeze eggs or embryos using protocols that add letrozole to keep estrogen levels lower during stimulation. Discuss timing and safety with both your oncologist and fertility specialist.
Sources
- ASCO — Fertility Preservation in People With Cancer: ASCO Guideline Update
- ASRM — Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion
- ASRM — Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion
- NY DFS — IVF and Fertility Preservation Law Q&A Guidance for Issuers
- NCI — Fertility Issues in Girls and Women with Cancer
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.