Fertility Preservation

By Dr. Avanthi Vellala

She was 30. One year of marriage. Not actively trying for a baby yet. Regular cycles, decent ovarian reserve. Life was going normally.

And then, in August 2025, she found swellings on the left side of her neck.

She was treated for tuberculosis for six months. The swellings didn’t go away. A repeat ultrasound showed multiple enlarged bilateral cervical lymph nodes. An excision biopsy in May 2026 confirmed it lymphoma. IHC markers confirmed Hodgkin’s lymphoma.

She needed to start chemotherapy. She had 20 to 25 days.

Fertility preservation was advised. She met another consultant before she came to me.

This is something I want people to understand. Chemotherapy, while life-saving, can be deeply damaging to ovarian reserve. The drugs used in cancer treatment are often toxic to eggs. Some women recover their ovarian function after treatment. Many don't. And for those who don't, the eggs frozen before chemotherapy may be the only biological link to a child of their own. This is why fertility preservation before starting chemotherapy is not optional it is urgent. Twenty days felt like very little. But it was enough. And that window had to count.

She walked in on day 11 of her cycle. The right ovary already had a dominant follicle at 14.5mm. AFC of 12 and 11. There was something to work with.

I explained the process. I didn’t give them false hope. I also told them something many couples in their position don’t hear that embryo freezing is better than egg freezing when you’re married and stable in the relationship. The fertilised embryo has a higher survival rate post-thaw. They understood. They spoke about finances. And we moved forward.

I wanted to do a random start IVF protocol. Time was the constraint. I triggered the dominant follicle with HCG and called them back 36 to 48 hours later.

The day before they were due, they texted. They had an oncology appointment. Was it mandatory to come at the exact advised time?

I told them the oncology appointment comes first, always. But if they could come after, it would be the right time to start stimulation. I only had 20 days. I didn’t want to waste a single one.

They came.

I wanted to check semen parameters before starting the cycle. Her husband was under enormous stress that day. He said he’d do it later. I understood this happens. Men carry stress differently and it shows up in exactly these moments.

I started stimulation. The dominant follicle had ovulated which I was counting on. And then, something I can only describe as lucky, the remaining cohort of follicles was synchronous. They came up together. This doesn’t happen most of the time with random start protocols. I’ll take it.

A day later, her husband tried to produce a sample at the clinic. He couldn’t. The stress was too much. I asked for a home collection instead.

He collected the sample at home.

And guess who dropped it to us.

His wife. The patient. The one with Hodgkin’s lymphoma. She walked in herself, sample in hand, ready to move forward.

I didn’t say anything in that moment. Some things don’t need a response.

Stimulation ran for 11 days. We were expecting around 20 eggs. We retrieved 14. Ten were mature. All ten fertilised. We used microfluidics for sperm selection. By day five 9 blastocysts. We froze 8 beautiful ones.

Before ICSI, I spoke to my embryologist Gayathri extremely skilled, deeply meticulous. I told her I want you, the senior, doing this ICSI. This patient may not get another chance at a cycle. She may not be able to freeze embryos after chemotherapy. This has to be our best work.

I tried my best. She tried hers. Eight blastocysts, frozen and waiting.

When someone comes to me for fertility preservation before chemotherapy, here is what I do. I assess how much time we have and what is realistically the best I can do in that window. I never promise a 100% successful cycle. And especially not to someone who is already fighting a cancer diagnosis I’m not going to add unrealistic statistics to that weight.

They asked me many questions. I answered every one.

Not every follicle contains an egg. Not every egg is mature. Not every mature egg becomes a good quality blastocyst. They knew going in what the possible outcomes were. They were prepared. They should be.

In this case, the outcome was good. I know that. And I’m happy.

I don’t know what this girl is carrying inside. I don’t know how frightened she is. But the courage and confidence she showed walking through every step of this without flinching is something I keep thinking about.

She is super cute, by the way.

Is your baby going to be even cuter? I think yes.