Synopsis
Offer timely, equitable fertility-preservation choices before medical harm, obtain lawful informed consent, and navigate storage, donation, future-child and posthumous-use decisions transparently.
- Discuss fertility preservation at the earliest opportunity with anyone whose medical condition or planned treatment is likely to impair fertility, and expedite the discussion when treatment is urgent.
- Offer sperm cryopreservation to people of reproductive age at risk; offer oocyte or embryo cryopreservation as appropriate to people with ovaries of reproductive age.
- Consider ovarian-tissue cryopreservation when oocyte or embryo freezing is not feasible, including before puberty; testicular-tissue cryopreservation remains experimental and belongs in research pathways.
- For NHS-funded medical preservation, do not apply conventional fertility-treatment eligibility criteria, including the lower age limit; eligibility at the later time of using stored material is a separate question.
- Written informed consent is legally required for use and storage, after information and an offer of counselling; embryo storage and use require effective consent from both gamete providers.
- For use in treatment, gametes and embryos may be stored for up to 55 years from first storage if the patient renews storage consent every 10 years and keeps clinic contact details current.
- Consent can be changed before embryo transfer or insemination; posthumous use, use after loss of capacity, donation, research and training require specific choices rather than assumed general consent.
- Donor-conceived people can request non-identifying donor information at 16 and, when conceived with an identifiable donor, identifying details at 18.
Key red flags
Imminent chemotherapy, pelvic radiotherapy, gonadectomy or gonadotoxic transplantation conditioning requires same-pathway fertility-preservation referral.
Acute leukaemia or another disease in which ovarian stimulation would dangerously delay treatment or reintroduce malignant cells requires specialist alternatives, not routine stimulation.
Lack of decision-making capacity, possible coercion or uncertainty about legal parenthood requires senior, legal and safeguarding input before gametes or embryos are created or used.
Missing or expired consent can make storage or use unlawful; withdrawal prevents use and may trigger the statutory embryo-storage cooling-off period, so contact the licensed clinic urgently.
Proposed posthumous use without explicit effective consent and a properly named recipient cannot be improvised after death.
Investigation priorities
Estimate whether fertility is threatened and how much time is safely available before treatment.
Management branches
A condition or planned treatment is likely to impair fertility.
- Discuss future fertility and parenthood goals immediately and obtain permission for rapid reproductive-medicine referral without assuming current family plans.
- Share diagnosis, treatment regimen, urgency, infection status and prognosis between the treating team and fertility service.
- Select sperm, oocyte, embryo or ovarian-tissue preservation from anatomy, puberty, time, reserve, risk and informed preference, and document when no safe option exists.