Fertility Preservation Program

The goal of the Fertility Preservation Program at SickKids is to meet with patients whose medical conditions or treatments may put their fertility at risk. Early education about fertility risks helps patients and their families decide if fertility preservation is suitable for them. We aim to help patients and their families understand the strengths, limitations, successes, and science behind each fertility preservation option.

"We know how important future fertility can be for patients and families receiving care at SickKids. We are committed to guiding each patient and family through fertility preservation options with expertise, scientific innovation, cultural sensitivity and unwavering support at every step."

Dr. Kriti Kumar and Dr. Jennia Michaeli, program co-directors

Why is this important?

Fertility refers to a person’s ability to use their own sperm (people with testes) or eggs (people with ovaries) to have a baby. Medical conditions or treatments, such as chemotherapy, radiation or surgery, can affect this ability.

Fertility preservation involves saving sperm, eggs, or tissue to allow individuals to have genetically related children in the future. It is hard to predict what someone may want later in life. Some may want to be parents, others may not, and some may be unsure. Fertility preservation provides that choice. There are also other ways to build a family, including adoption or using donor eggs or sperm.

How is fertility risk assessed?

Not all cancer-directed therapies affect fertility in the same way. The primary oncology team performs fertility risk assessment based on multiple factors, including but not limited to the anticipated disease-directed therapy, age, and pubertal status. For patients who are considered to have a high risk for future infertility, fertility preservation options will be discussed, and the appropriate strategies will be offered.

Fertility preservation options

The SickKids Fertility Preservation Program provides many options for children and adolescents whose fertility may be at high risk.

Patients with ovaries

Also known as ovarian tissue freezing, is a procedure for children and adolescents who require urgent treatment (e.g. chemotherapy or radiotherapy) or unable to preserve their fertility through egg freezing. For example, if they are young or are not far enough along in puberty.

The process:

OTC involves surgically removing one ovary in a hospital (laparoscopic surgery). The ovary is then brought to Mount Sinai Fertility, where the tissue is processed, frozen and stored for future use in reproduction.
Part of the tissue is tested for the presence of malignant cells (in a child with cancer) and the content of oocytes. Samples are also kept for future testing.
When a child or adolescent is older and if they wish to have children, the pieces of ovarian tissue can be put back (transplanted) into the person. Children may be conceived spontaneously or through In-Vitro Fertilization (IVF).
The hormone function, including having periods, is also restored in many individuals after ovarian tissue transplantation.

Also commonly known as egg retrieval or egg freezing, is a procedure available for individuals who have gone through puberty (i.e. have periods). This process involves using injectable medications to stimulate the growth of multiple follicles in the ovary. Each follicle has the potential to contain an oocyte. This takes approximately 10 to 14 days.

The process:

Bloodwork and ultrasounds (where a probe is placed in the vagina to check the ovaries) are done to see how many follicles are developing.
At the end of the process, the oocytes are retrieved using a needle under ultrasound guidance. Most often, retrieval occurs through the vagina under conscious sedation (relaxed but not fully asleep) at Mount Sinai Fertility.
The oocytes are then frozen and stored at Mount Sinai Fertility.
In the future, the oocytes can be thawed and combined with sperm to create an embryo through In-Vitro Fertilization (IVF). The embryo can be carried by the patient or a gestational carrier.

GnRH agonist (e.g. Lupron or Zoladex) works by suppressing the hormonal function of the ovaries. This is currently considered an investigational method as evidence of its effectiveness to preserve fertility is lacking. GnRH agonist therapies may still be used to stop periods (menstrual suppression) during certain treatments to avoid excessive loss of blood.

Patients with testes

Regardless of how sperm is collected (see below for options available), it is delivered to Mount Sinai Fertility, where sperm is analyzed under a microscope and frozen. Some individuals may need to repeat this process depending on the initial sample quality.

When a child or adolescent is older and if they wish to have children, the sperm can be thawed and used to have children through In-Vitro Fertilization (IVF).

Ways sperm can be collected

Below are some ways sperm can be collected to support the preservation process.

Sperm banking
A sperm sample is produced through masturbation. This may be done at home, at Mount Sinai Fertility Clinic, or at SickKids in a private area
Electroejaculation
This procedure uses electrical energy to allow a person to produce a sperm sample. This procedure is done while asleep (under general anesthesia) at SickKids.
Testicular sperm extraction (TESE)
This surgical procedure involves extraction of sperm and may be done on someone who has had enough puberty changes to have mature sperm.

Testicular biopsy is the process of taking a small amount of tissue using an incision in the testicle. This testicular tissue is then frozen for future use. This process is considered experimental and can only be done in a research study. This is the only fertility preservation option for boys who have not undergone puberty.

Educational resources

Below are some resource curated to provide more information on for fertility preservation.

Brochure for patients with ovaries

Informative brochure providing information on fertility preservation for patients with ovaries.

Brochure for patient with testes

Informative brochure providing information on fertility preservation for patients with testes.

Teens Cancer Connection

resources that are available for teens

Fertile Future

non-profit organization that provides support services to cancer patients and oncology professionals

Ontario Fertility Program

information on how to get access to government-funded fertility services

Egg freezing and preservation process video

white board video outlining the process of egg/oocyte preservation for young women

Our team

The SickKids Fertility Preservation Program is co-led in collaboration and close partnership with the team at Mount Sinai Fertility. This initiative brings together numerous individuals across specialties,including Haematology/Oncology, Paediatric and Adolescent Gynecology, Endocrinology, Urology, Pathology, Informatics, Education, Implementation Science and the Haematology/Oncology Family Advocacy Committee (FAC).