Navigating the complex intersection between fertility preservation for cancer patients and pandemic challenges
Imagine being a young woman recently diagnosed with breast cancer, needing to start life-saving chemotherapy within weeks—treatment that could permanently destroy your fertility. Now imagine facing this reality during the height of the COVID-19 pandemic, when hospitals were limiting procedures and the fear of infection loomed everywhere. This was the impossible situation countless cancer patients faced when the world shut down in spring 2020. Two time-sensitive crises suddenly converged: the urgent need to preserve fertility before gonadotoxic cancer treatments, and the global pandemic demanding restricted medical services.
The pandemic created an ethical dilemma: was fertility preservation for cancer patients an "elective" procedure or an essential service that needed to continue despite infection risks?
This article explores how the medical community navigated this complex intersection between oncofertility—the field dedicated to preserving fertility for cancer patients—and the unprecedented challenges of the COVID-19 pandemic. Through innovative adaptations, crucial research, and unwavering patient advocacy, healthcare professionals found ways to balance these competing emergencies, ensuring that young cancer patients wouldn't have to sacrifice their future family-building dreams while fighting for their lives.
Oncofertility is a specialized medical discipline that bridges oncology and reproductive medicine. It focuses on preserving fertility in patients facing cancer treatments that could compromise their reproductive potential. For these patients, fertility preservation isn't elective—it's an urgent medical necessity that must be addressed before chemotherapy, radiation, or surgeries that could permanently damage their reproductive function.
Chemotherapy and radiotherapy can destroy ovarian follicles, leading to premature ovarian failure and infertility.
Cancer treatments can damage sperm production, causing temporary or permanent infertility depending on treatment protocols.
Day 0: Patient receives cancer diagnosis requiring gonadotoxic treatment
Days 1-3: Urgent referral to fertility specialist for counseling on preservation options
Days 4-21: Completion of chosen fertility preservation method (sperm banking, egg/embryo freezing, etc.)
Day 21+: Start of chemotherapy, radiation, or other cancer therapies
The window for fertility preservation is narrow—typically just two to three weeks between cancer diagnosis and the start of treatment. In this brief period, patients must receive specialized counseling, make complex decisions about preservation options, and complete the chosen procedures. This already challenging timeline would become exponentially more complicated during the COVID-19 pandemic.
When COVID-19 emerged as a global threat in early 2020, healthcare systems worldwide faced overwhelming pressure to prioritize pandemic response. Medical societies initially recommended suspending non-urgent elective procedures, including most fertility treatments, to conserve resources and minimize infection risk. However, this created significant confusion about where oncofertility procedures fit into this new framework.
"Was fertility preservation for cancer patients an 'elective' procedure that could be postponed, or an essential service that needed to continue despite pandemic risks?"
The oncofertility community quickly united around a clear message: for patients facing gonadotoxic therapies, fertility preservation is urgent and time-sensitive, not elective 1 .
| Time Period | Patients Counseled | OTC Procedures Performed | Patients Unable to Preserve Fertility |
|---|---|---|---|
| Pre-pandemic (March 2019-Feb 2020) | 105 | 82 | 23 |
| Pandemic (March 2020-Feb 2021) | 97 | 75 | 22 |
| Post-pandemic (March 2021-Feb 2022) | 103 | 77 | 26 |
Table 1: Ovarian Tissue Cryopreservation Procedures Before and During the Pandemic 6
Despite the dramatic healthcare disruptions, this center maintained consistent OTC activity throughout the pandemic 6 . The slight variations in numbers reflect the ebb and flow of clinical capacity rather than a complete cessation of services, demonstrating that with proper adaptations, essential oncofertility care could continue.
One of the most pressing questions early in the pandemic was whether SARS-CoV-2 could be present in reproductive tissues and fluids. Understanding this was critical for determining whether fertility preservation procedures could safely proceed without risking transmission through cryopreserved samples.
In a multicenter prospective study conducted across 12 French university medical centers, researchers set out to answer this question with cancer patients specifically in mind 2 . The study, conducted between July 2020 and June 2021, enrolled 129 men seeking fertility preservation before potentially gonadotoxic cancer treatments.
The findings provided much-needed clarity amid the initial uncertainty of the pandemic:
| Patient Group | Number of Patients | SARS-CoV-2 in Semen | Ejaculate Volume | Sperm Motility | TNF-α Level |
|---|---|---|---|---|---|
| Uninfected | 50 | Not detected | 4.6 mL | Normal | 0 pg/mL |
| PCR+ (Active Infection) | 8 | Not detected | 2.6 mL* | 32.5%* | 1.9 pg/mL* |
| Seropositive (Previous Infection) | 5 | Not detected | Normal | 50% | Normal |
Table 2: SARS-CoV-2 Detection and Semen Parameters in Study Participants 2
*Statistically significant difference compared to uninfected group
SARS-CoV-2 RNA was not detected in the seminal fluid or spermatozoa of any participants, including those with active infections 2 .
Men with active COVID-19 infections had significantly lower ejaculate volumes and reduced sperm motility compared to uninfected men.
This research provided crucial evidence for clinical decision-making during the pandemic. The absence of SARS-CoV-2 in semen meant that sperm banking could safely continue for cancer patients, even those with active COVID-19 infections. At the same time, the observed alterations in semen parameters highlighted that systemic inflammation from COVID-19 could temporarily affect male reproductive function—an important consideration for fertility planning.
For the oncofertility field, these findings supported the continued practice of semen cryopreservation while emphasizing the importance of COVID-19 testing and appropriate safety protocols.
The study investigating SARS-CoV-2 in semen utilized several important laboratory techniques and reagents that formed the essential "toolkit" for this critical research.
| Reagent/Method | Function/Application | Specific Example/Kit |
|---|---|---|
| RT-PCR Testing | Detection of SARS-CoV-2 RNA in nasal swabs and semen samples | TaqPath COVID-19 RT-PCR (ThermoFisher) |
| Density Gradient Centrifugation | Separation of spermatozoa from seminal plasma for individual analysis | Two-stage (90/45%) discontinuous gradient |
| Antibody Detection Assays | Identification of previous SARS-CoV-2 infection through IgG/IgM antibodies | ELISA immunoassays (Abbott, Roche, Euroimmun) |
| Cytokine Measurement | Quantification of inflammatory markers in seminal fluid | ELISA for TNF-α detection |
| SARS-CoV-2 RNA Extraction | Isolation and purification of viral RNA from samples | ELITe InGenius SP 200 (ELITechGroup) |
| Semen Analysis | Evaluation of standard semen parameters according to WHO guidelines | WHO 2010 guidelines |
Table 3: Essential Research Reagents and Methods in COVID-19 Oncofertility Research 2
These research tools enabled scientists to comprehensively evaluate both the safety considerations (viral presence) and potential functional impacts (sperm quality changes) of COVID-19 on male fertility preservation—essential information for guiding clinical practice during the pandemic 2 .
Faced with the dual challenges of maintaining urgent oncofertility services while minimizing COVID-19 risks, clinics worldwide implemented creative solutions and safety adaptations. The approaches that emerged represent a remarkable example of healthcare flexibility in crisis.
Oncofertility programs quickly established strict safety protocols to protect vulnerable cancer patients and healthcare staff.
Universal SARS-CoV-2 testing before any fertility preservation procedures, typically via nasopharyngeal swab with RT-PCR analysis 6 .
Enhanced personal protective equipment for medical staff, including N95 masks, face shields, and gowns.
Structural changes to clinical spaces, including plexiglass barriers, distanced waiting room chairs, and intensified sanitation protocols 6 .
Some centers established backup teams of fertility specialists who could take over if the primary team was exposed to COVID-19 1 .
Perhaps the most significant innovation was the rapid expansion of telehealth services for oncofertility counseling. With in-person visits limited, healthcare providers turned to video consultations to maintain essential patient communication and decision-making support.
One notable example was the Italian "insenoaallasalute.it" project, a web-based platform designed to maintain breast cancer awareness and oncofertility services during lockdowns 5 .
Account Activations
Self-Evaluation Tests Completed
Patients Selected for Telehealth Consultation
Telemedicine offered unexpected benefits beyond infection control. Virtual consultations eliminated travel burdens for patients already facing cancer-related fatigue and reduced the time away from work or family responsibilities. For some, the convenience of accessing specialists from home reduced the overwhelming logistical challenges of coordinating cancer care.
The collision between the COVID-19 pandemic and the time-sensitive field of oncofertility created extraordinary challenges for patients and providers alike. Yet this crisis also spurred remarkable innovations, collaborative problem-solving, and valuable research that will benefit patients long after the pandemic subsides.
Most importantly, the pandemic highlighted the incredible resilience of both patients facing cancer during this turbulent time and the medical professionals dedicated to preserving their future fertility options. As we reflect on this period, it's clear that the oncofertility community's response has not only navigated an immediate crisis but has also strengthened the field's capacity to handle future challenges.
"The convergence of COVID-19 and oncofertility serves as a powerful reminder that even amid global emergencies, life-changing personal milestones like future family building remain worthy of protection and prioritization."
For young cancer patients, whose reproductive timelines cannot be paused for pandemics, this ongoing commitment represents hope in the face of multiple uncertainties.