Oncofertility Expands as Younger Cancer Patients Turn to New Fertility Preservation Technologies
核心洞察
Cancer diagnosis rates in people under age 50 rose roughly 22% from 2000 to 2023, driving rapid growth in the oncofertility field.
Fertility preservation consultations for cancer patients surged, with Boston IVF's New England clinics rising from 19 patients in 2015 to 183 in 2025.
A Dana-Farber trial found early, hormone-sensitive breast cancer (搜索) survivors could pause hormone therapy for up to two years to conceive without raising recurrence risk.
Younger people are being diagnosed with a range of cancers at growing rates, disrupting their lives and threatening their fertility. But new technologies, cancer doctors, and reproductive specialists are working together to give more patients a chance to have children post-treatment, in the growing field known as oncofertility.
Bridging the fields of oncology and reproductive health, oncofertility is not so much an official medical specialty, but a term that reflects the growing recognition of the need to help younger cancer patients protect their ability to have children. The concept emerged around 2006, with the release of some of the first guidelines surrounding fertility preservation for cancer patients and the creation of the Oncofertility Consortium network, which provides support to survivors and those undergoing treatment. The field has expanded in the two decades since, gaining momentum as more reproductive-age patients have been diagnosed and better treatments have prolonged their survival.
A Rising Tide of Early-Onset Cancers
The rise in such cancer cases is stark: diagnosis rates in people under age 50 have increased some 22 percent from 2000 to 2023, according to the National Cancer Institute. Breast cancer (搜索) rates for women younger than 50 are rising about 1.4 percent each year, data show. And with more people having children later in life, many are diagnosed before starting families or even deciding if that is what they want.
"We want them to not only survive but we want them to be able to thrive and live the fullest life possible," said Dr. Ann Partridge, director of the Program for Young Adults with Breast Cancer (搜索) at Dana-Farber. "For many of our young adults, that entails still having biologic children."
Growing Demand for Fertility Preservation
The demand for fertility preservation among cancer patients has grown sharply. At Boston IVF, a network of fertility clinics in 10 states, the number of cancer patients in its New England clinics who have come in for a consultation has risen from 19 patients in 2015 to 183 patients in 2025. One Boston-based team found that the number of cancer patients nationwide who preserved their eggs more than doubled between 2014 and 2019. From 2022 to 2025, referrals for fertility preservation for oncology patients at Brigham and Women's Hospital increased by 49 percent, according to Mass General Brigham (搜索).
At the same time, innovations in reproductive technologies have ushered in new possibilities. Freezing ovarian tissue has enabled childhood cancer patients to preserve their fertility before hitting puberty. Women now regularly freeze their eggs, without the need for sperm or fertilized embryos.
"It's come a long, long way, and egg freezing has been the biggest part of that," said Dr. Mary Morris, a reproductive endocrinologist at Boston IVF.
Barriers to Access
The biggest challenge in fertility preservation for cancer patients is the time pressure, Morris said. Many patients need to find a fertility specialist and undergo preservation — sometimes a weeks-long process — before their cancer treatments start. And this rush happens as people are still grappling with their diagnosis.
At Terra Fertility in Boston, Dr. Denis Vaughan, a reproductive endocrinologist and co-founder, said he lets cancer patients skip his months-long wait list, seeing them within 48 hours. But some patients still struggle to be seen. John Ballou called multiple fertility clinics for sperm banking after getting diagnosed with the blood cancer Hodgkin's lymphoma (搜索) in 2023, at age 23. But he either didn't meet their criteria or didn't have the right insurance. The delay lasted nearly a month, until his oncologist at Mass General Brigham (搜索) called a clinic and got him an appointment.
"I was getting very stressed out. Like, is this going to affect my chances?" said Ballou, now 27. "Do I even want to have kids? It was a big conversation."
Others don't realize that fertility preservation is an option. Among early-onset patients diagnosed from 2013 to 2021, about half reported talking with their health care team about it, according to a 2024 study. Patients in the Northeast are more likely to get counseling or take steps to preserve their fertility than those in other parts of the US, some studies have found.
Cost and Insurance Coverage
Cost is also a consideration. Without insurance, embryo freezing can cost up to $20,000, according to the Alliance for Fertility Preservation, but insurance coverage is expanding. In 2017, Connecticut and Rhode Island became the first two states to pass legislation mandating the coverage of preservation for people with medical conditions including cancer. New Hampshire and Maine followed, and Massachusetts passed legislation in 2024.
Those laws, however, only apply to certain health plans, so many patients, including those on Medicaid, don't receive benefits. Some of the laws also don't address storage fees for frozen eggs or sperm. Within two years of his diagnosis, Ballou had racked up some $2,000 in debt on storage fees. The nonprofit Worth the Wait, which helps fund fertility preservation and adoption for cancer patients, wiped out that bill, but Ballou is still paying a $110 monthly fee.
"Fertility treatments in general, it's seen as a luxury problem, and it's not, especially for cancer patients," said Mike Scherer, co-founder of Worth the Wait.
Evidence on Pausing Hormone Therapy
The growing momentum around this issue has also spurred new research. Partridge and her team at Dana-Farber found that survivors of early, hormone-sensitive breast cancer (搜索) could pause their hormone therapy for up to two years to get pregnant, without raising the risk that their cancer would come back. Five years into the trial, some 69 percent of the women had at least one baby after pausing their treatment.
"This study put the nail in the coffin for the concern that pregnancy itself might increase the risk of cancer recurrence," Partridge said.
That is what Jenilee Crowley did. After successful treatment for her stage one breast cancer (搜索), diagnosed in 2022, Crowley was supposed to take the drug tamoxifen for five years to help prevent a recurrence. But after two years, she stopped taking it. The couple froze embryos and started trying for a baby. They tried naturally but had multiple miscarriages, and the first of their three embryos failed to transfer. Then, the second embryo took, and their son Archer was born this past March.
The Crowleys are also debating whether to use their final embryo to fulfill their dream of having a second child — or if Crowley should get back on treatment as soon as possible. She's already taken the full two years off. There is no data to show whether extending that time is dangerous.
"I'm hoping that it is a best-case scenario, but I am taking a risk with my life, essentially, and my health," Crowley said. "It weighs on me every day."
Right now, she is leaning toward taking a chance on the last embryo: "I just feel like it really is, for me, now or never."