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Ask the child’s treating team and a reproductive specialist to explain the fertility risks of the specific diagnosis and treatment plan, how quickly a decision is needed, which options fit the child’s age and health, and what each option can realistically do. Also discuss the child’s participation, the burden and timing of a procedure, long-term storage, and other possible paths to building a family. Fertility preservation may keep future possibilities open, but it cannot guarantee future fertility, pregnancy, or a child.
The questions below are intended to help families prepare for an individualized discussion, not to replace clinical advice. They reflect U.S.-based guidance in the American Society for Reproductive Medicine’s 2026 committee opinion on medical indications for fertility preservation and its 2026 ethics opinion. Availability, laws, and clinic policies can differ by location.
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How could cancer treatment or another medical treatment affect my child’s future fertility?
Start with the child’s actual diagnosis and proposed treatment—not a general estimate for children with a similar condition. Ask the treating clinician to identify which medicines, doses, radiation fields, or surgeries could affect the ovaries, testes, reproductive organs, or the body’s ability to sustain a future pregnancy. The risk varies by disease and regimen, and some aspects may not be fully known when counseling takes place, according to ASRM’s 2026 medical-indications guidance.
- Which parts of the planned treatment are most relevant to future fertility, and how might they affect reproductive function?
- What is known about this particular regimen, and what remains uncertain?
- Could treatment changes alter the fertility risk, and would any alternative be medically appropriate?
- Could the child’s underlying condition or later health make pregnancy unsafe, even if reproductive material is preserved?
- When and how might the child’s reproductive health be assessed in the future?
Ask the team to distinguish the chance of damage to reproductive function from the chance that a particular preservation method could later be used successfully. Those are different questions. A specialist can explain which evidence applies to the child’s diagnosis, treatment, age, and health rather than implying that a general outcome applies to every patient.
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How quickly must we decide, and what is the cost of waiting?
Ask for a timeline tied to the treatment plan. ASRM recommends prompt counseling and referral when fertility may be affected, while taking the child’s health, safety, and treatment urgency into account. A referral can often be discussed before treatment begins, but that does not mean treatment should automatically be postponed to pursue preservation.
- Ask the treating team when treatment is expected to start and whether that date is medically flexible.
- Ask the reproductive specialist how soon the child would need evaluation, testing, or a procedure for each clinically suitable option.
- Ask whether a proposed procedure would delay essential treatment, and what the medical risks of changing or delaying standard treatment would be.
- Ask whether the child’s current condition makes anesthesia, surgery, or another procedure unsafe or impractical.
- If the local hospital cannot provide the service, ask for an expedited referral and for the treating team to coordinate records and timing.
Request a clear explanation of the trade-off: what could be gained by acting now, what could be lost by waiting, and what the risks are of interrupting or modifying care. The relevant comparison is not simply “preserve now” versus “preserve later”; it includes the consequences for treatment and the child’s immediate medical safety.
Which options fit my child’s age, development, health, and treatment plan?
There is no single best method for every child. Eligibility and suitability depend on the child’s age and pubertal development, diagnosis, treatment schedule, health, and personal circumstances. Ask the specialist to separate options that are established for the relevant situation from those still considered investigational, and to explain why an option does or does not fit this child.
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| Child’s situation | What ASRM’s 2026 guidance identifies | Questions for the specialist |
|---|---|---|
| Prepubertal girl | Ovarian tissue cryopreservation is identified as the principal method for cryopreserving gametes in prepubertal girls. | What does the procedure involve for this child, what tissue would be stored, and what is known about its possible future use? |
| Selected postpubertal girl | Oocyte or embryo cryopreservation may be an option when medically appropriate. | Does the child’s development, health, treatment timeline, and personal situation make either method suitable? |
| Prepubertal boy | Testicular tissue cryopreservation is considered investigational. | What does investigational mean for this method, what uncertainties remain, and what alternatives or future paths should we understand? |
This table describes categories in the U.S.-based guidance, not a recommendation for a particular patient or a guarantee that a service is available locally. Ask what options the clinic actually offers and whether referral to another program is appropriate. If a method is investigational, ask the team to explain its status plainly, including what is not yet established about later use.
What would each procedure involve, and what might it realistically accomplish?
For each option the specialist considers appropriate, ask for a practical description rather than only the name of the method. Find out what is collected or created, how the procedure is performed, whether anesthesia is involved, what discomfort or recovery to expect, and what medical risks apply to this child. Ask how the proposed procedure fits around other care and what monitoring or follow-up it requires.
- What steps would happen before, during, and after the procedure?
- What are the risks of the procedure and anesthesia given the child’s current health?
- How much time would evaluation and treatment take, including recovery?
- What would need to happen for the stored material to be used in the future?
- What is known—and not established—about the possibility of using this material later?
Ask the clinician to explain the limits of the evidence for the child’s circumstances. The method and potential benefit depend on the individual patient and the clinical situation. Cryopreservation does not ensure that stored material will remain usable, that a future treatment will be medically possible, or that a future pregnancy or child will result. Avoid treating a storage procedure as if it were a promise of a specific family-building outcome.
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How should my child take part in the decision?
A child’s role should reflect their developmental ability to understand the decision. ASRM’s 2026 ethics guidance supports presenting information in a developmentally appropriate way and seeking assent when a minor can understand and participate. A parent or guardian provides permission, guided by the child’s best interests. The process should make room for the child’s questions and feelings rather than assuming that a parent’s preference is the child’s preference.
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- What does the child understand about the procedure, storage, and possible future use?
- Can the child assent, and do they wish to do so?
- How will the team respond if the child is uncertain, distressed, or does not want a procedure?
- Can a mental-health professional help the child and family talk through the decision?
Ask how the child’s views will be revisited if the plan changes or new information becomes available. Developmental participation is not a one-time formality: the child may need opportunities to ask questions as they mature and better understand what was stored and what choices could arise later.
What happens to stored material over time?
Preservation creates a continuing responsibility, not just a one-time medical decision. Before agreeing, ask the clinic to explain its storage arrangements and written policies in terms the family can understand. ASRM’s medical-indications guidance and ethics opinion address storage and disposition, including revisiting disposition when a minor reaches adulthood.
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- Where will the material be stored, who is responsible for it, and what is the expected duration of storage?
- What fees apply, who must pay them, and what happens if payments stop?
- What happens if the clinic cannot reach the family or the family moves?
- Can the material be transferred to another facility, and what conditions or costs apply?
- What local law and clinic policy govern future use, transfer, or disposition?
- How are death and other contingencies addressed in the clinic’s agreements?
- How will the child be involved in reviewing disposition agreements on reaching adulthood?
Read the consent and storage documents carefully, including provisions for situations the family may not expect to face now. Ask the clinic to explain any limits on who may authorize use or disposition and whether the agreement can be updated. Legal requirements and institutional policies vary, so a general description should not be treated as a substitute for the applicable local terms.
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Ask whether the child’s treating clinician, a pediatric or adolescent fertility specialist, and other relevant specialists can coordinate their advice. Depending on the child’s needs, a mental-health professional may also help. Team-based counseling matters because a preservation decision must fit both the medical plan and the child’s circumstances.
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- Who is the family’s main contact for questions about the treatment timeline and fertility referral?
- Can the treating team send records and coordinate a rapid consultation?
- If the hospital does not provide a relevant service, where can the family be referred?
- Who can explain fees, insurance questions, financial assistance, or other practical barriers?
- Can the child and family speak with a counselor about the emotional and developmental aspects of the choice?
ASRM recommends that programs without a particular service still explain relevant options and make a prompt referral. If a referral is needed, ask who will arrange it and what information the receiving specialist needs so that the family is not left to coordinate a time-sensitive process without support.
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What other paths to family-building might remain?
Ask the specialist to discuss what future use of preserved material could involve, as well as other possible paths. Depending on the person’s health and circumstances, those may include later fertility treatment, donor gametes or embryos, a gestational carrier when relevant, adoption, or choosing not to have children. These possibilities are not interchangeable, and none should be presented as a simple substitute for another.
For each path that may be relevant, ask how the child’s future health, prognosis, prior treatment, and any preserved material could affect eligibility or feasibility. Ask which questions cannot be answered now and what information might become clearer over time. ASRM guidance supports discussing alternatives and limitations as part of counseling; a specialist can explain which alternatives are relevant to this child without presuming what the child will want as an adult.
How can families make the consultation productive?
Families do not need to arrive with a decision already made. A short written list can help ensure that the discussion covers both urgent medical timing and long-term consequences. Bring the proposed treatment plan if available, note the questions the child has raised, and ask for explanations of unfamiliar terms before signing consent or storage documents.
- Ask the team to summarize the specific fertility risks and the uncertainties for this child.
- Write down the treatment start date, referral contact, and any decision deadline the clinicians identify.
- Request a side-by-side explanation of only those options the specialist considers clinically suitable, including burden, timing, evidence status, and possible future use.
- Include the child in the conversation at a developmentally appropriate level and ask how assent will be handled.
- Review storage, fee, transfer, and disposition terms, including what happens when the child becomes an adult.
- Ask who will coordinate referrals, practical support, and follow-up if the family needs more time or information.
The purpose of the discussion is to reach an informed, individualized choice that respects the child’s health, treatment needs, development, and future autonomy. ASRM’s 2019 committee opinion on fertility preservation in patients undergoing gonadotoxic therapy has been superseded by its 2026 medical-indications opinion; the current guidance and local clinic policies should therefore shape counseling.
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