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Fertility Care when Considering CRS/HIPEC

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CRS/HIPEC can impact your reproductive health and hormone levels. Ask your oncology team for a fertility specialist referral before treatment begins to safely explore your options. Early planning ensures you keep all your family-building choices open.

Preparing for cytoreductive surgery (CRS) with HIPEC involves many important decisions. One topic that is often overlooked—but deeply important—is fertility.


CRS/HIPEC and related cancer treatments can affect reproductive health, hormone function, and the ability to build a family in the future. Talking about fertility early—ideally before surgery or systemic therapy—helps ensure you have options and can make informed choices about your future.[1]

Why Fertility Care Matters Before CRS/HIPEC

CRS/HIPEC is an intensive treatment. Depending on your cancer type and surgical plan, it can impact fertility in several ways. These may include:


  • Removal of reproductive organs (ovaries, fallopian tubes, uterus)

  • Damage to ovarian reserve from chemotherapy exposure

  • Early or immediate menopause

  • Hormonal changes affecting egg quality or menstrual cycles

  • Scar tissue or adhesions that may affect future pregnancy


Cancer treatments—including surgery and chemotherapy—are known to impair fertility and reproductive function.[1,2]


Even if having children is not a priority right now, preserving fertility can keep future options open—and provide a sense of control during a challenging time.

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Fertility Matters at Every Stage of Life

Fertility care is relevant for many people, including:


  • Young adults

  • Adults in their 20s, 30s, and 40s

  • Transgender and nonbinary patients

  • People unsure about having children

  • Patients who already have children but may want more


Clinical guidelines recommend that all patients of reproductive age be informed about potential fertility risks and preservation options before treatment begins.[1]

Fertility Preservation Options

Your options will depend on your medical situation and how quickly treatment needs to begin. Established fertility preservation methods include:[1,3]


Egg Freezing (Oocyte Cryopreservation)

  • A common and effective option for individuals with ovaries

  • Requires hormone stimulation followed by egg retrieval

  • Eggs are frozen for future use

  • Typical timeline: ~10–14 days[3]

Embryo Freezing

  • Eggs are fertilized with sperm before freezing

  • Often preferred by patients with a partner or those seeking higher success rates


Ovarian Tissue Freezing

  • A surgical option when treatment must begin quickly

  • Ovarian tissue is removed and frozen for future use

  • May help restore hormone function later


Ovarian Suppression During Chemotherapy

  • Medications may temporarily suppress ovarian function

  • Sometimes used alongside other preservation strategies


Sperm Banking

  • A fast, widely available option

  • Typical timeline: often completed within 24–48 hours[3]


Fertility Options After Surgery

Even if fertility is affected, there may still be ways to build a family:

  • IVF using previously frozen eggs or embryos

  • Use of a gestational carrier

  • Donor eggs or sperm

  • Adoption or fostering

Your oncology and fertility teams can help guide these decisions based on your health and goals.

When Should You Talk About Fertility?

As early as possible.

Ideally:

  • At diagnosis

  • During treatment planning

  • Before chemotherapy or CRS/HIPEC


National guidelines emphasize that fertility preservation discussions should occur before treatment begins, when the most options are available.[1]


In many cases, fertility preservation can be completed within a short timeframe and coordinated with cancer care.[1,3]

Questions to Ask Your Care Team

Ask Your Oncology Team:

  • Will my treatment affect my ability to have biological children?

  • Will CRS/HIPEC impact my reproductive organs or hormones?

  • Should I see a fertility specialist before treatment?

  • Do I have time for fertility preservation?


Ask a Fertility Specialist:

  • What options are safest for me?

  • What are the success rates at my age?

  • How quickly can we begin?

  • What are the costs and insurance coverage?

Menopause and Hormone Health

CRS/HIPEC may remove ovaries or trigger early menopause. This can affect:

  • Bone health

  • Heart health

  • Sexual health

  • Mood and sleep

  • Hormone levels


Loss of ovarian function and early menopause are known to have long-term health effects, and should be managed in coordination with your care team.[4]

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Emotional Support Matters

Fertility decisions often happen during an already overwhelming time. Many patients experience:

  • Anxiety or fear

  • Grief about potential loss of fertility

  • Feeling rushed

  • Information overload


Research shows that fertility concerns can significantly impact quality of life for cancer patients and survivors.[5]


Support is available through:


  • Oncology social workers

  • Mental health counselors

  • Patient navigators

  • Fertility specialists and nurses

  • Peer support groups


You don’t have to go through this alone.

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The Role of Caregivers

Caregivers can play an important role by:


  • Attending fertility appointments

  • Taking notes and asking questions

  • Helping with scheduling and logistics

  • Providing emotional support

  • Assisting with financial decisions

  • Advocating for early referrals


Fertility is not just a medical issue—it’s a shared family decision.

Insurance, Cost, and Financial Support

Coverage for fertility preservation varies, but patients may explore:


  • State insurance mandates

  • Employer benefits

  • Grants or nonprofit programs

  • Fertility clinic financial counseling


Many fertility centers offer programs specifically for patients undergoing cancer treatment.

Takeaway: Preserve Your Options

Your future family-building choices matter.


Fertility preservation often can be coordinated with cancer treatment without significant delays.[1] Early planning helps ensure you have the widest range of options available.


If you are preparing for CRS/HIPEC, consider speaking with a fertility specialist—even if you’re unsure about having children. Having information empowers you to make the decision that’s right for you.

References

1. Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2024;42(5):e365-e402. doi:10.1200/JCO.24.02782


2. Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1664-1678. doi:10.1016/j.annonc.2020.09.006


3. Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019;112(6):1022-1033. doi:10.1016/j.fertnstert.2019.09.013


4. Donnez J, Dolmans MM. Fertility preservation in women. N Engl J Med. 2017;377(17):1657-1665. doi:10.1056/NEJMra1614676


5. Quinn GP, Vadaparampil ST, Lee JH, et al. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009;27(35):5952-5957. doi:10.1200/JCO.2009.23.0250

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