From Urgent Questions to Lasting Pathways: Fertility Care at SickKids
For many children and adolescents with cancer, treatment is lifesaving. But these treatments can also impact something deeply personal — their future fertility and the potential for biological children. For years, nurses have heard similar questions from patients and families:
Will I be able to have children one day? Are there options? What are those options? Is it too late?
Without clear pathways, these questions were often left unanswered, and solutions were not always available. The need was clear: fertility preservation had to become timely, equitable, and normalized within pediatric oncology care.
In 2024, SickKids took a significant step forward by building a formal Fertility Preservation Program. The goal was to create an interdisciplinary, sustainable care pathway that facilitated standardized and timely access to fertility preservation for patients across varied diagnoses, ages, and urgency levels. Over 60 clinicians across disciplines — nursing, oncology, hematology, gynecology, endocrinology, pathology, urology, fertility specialists, informatics, social work, education, implementation science, and survivorship — with patient and parent partners, joined focused working groups to design care pathways that made sense in clinical settings. The group created detailed workflows to address referral processes, urgent and non‑urgent pathways, education, and survivorship considerations. Pathways for ovarian tissue cryopreservation (OTC), egg freezing, sperm banking, electroejaculation, and testicular sperm extraction (TESE) were clearly defined and implemented as standard of care.
The Nursing Role in Fertility Preservation
Nursing has been central to this work. In the first days of a new cancer diagnosis, nurses are consistently present at the bedside, making them instrumental in fertility pathways. Education and normalization were key early priorities. By equipping nurses with language, resources, and straightforward flow charts, the aim was to make these conversations informative and less uncomfortable for patients, caregivers, and the medical team. While fertility preservation counselling is often done by physicians, nurse practitioners, or physician’s assistants, nurses play an active role in identifying eligible patients, normalizing fertility discussions, reinforcing education, and supporting families through complex, emotional decisions.
The program also recognizes patients who are unable to undergo fertility preservation, whether due to treatment urgency, age, cultural/personal reasons, or medical contraindications. Nurses remain essential supports for these patients, both during treatment and in survivorship, validating grief, answering evolving questions, and reconnecting families with fertility resources, as needs change over time.
Collaboration at Its Core
A key strength of the program is collaboration with Mount Sinai Fertility, allowing SickKids’ patients timely access to specialized fertility expertise. Importantly, some aspects of fertility preservation are covered through provincial funding or hospital budgets; others are not, highlighting ongoing inequities in access.
At its heart, the SickKids Fertility Preservation Program reflects something nurses have always known: fertility matters. It matters to patients thinking about their future, to families planning for life beyond illness, and to survivors redefining what that future might look like. For nurses, this work is about more than procedures — it’s about listening, normalizing, advocating, and making space for hope, even in the hardest moments.
For more information and resources, visit the SickKids Fertility Preservation Program website.
This story was written for the spring 2026 issue of The RePORTer, POGO’s Nursing Newsletter, by SickKids staff Rebecca Côté, RN, Clinical Program Coordinator, Sarah Gabura, RN, MN, NP-Pediatrics, Dr. Kriti Kumar, Staff Oncologist, Haematology/Oncology.
Conversations With My Mom: A Childhood Cancer Survivor’s Guide to Awkward Health Talks
“Mom, why doesn’t that man have any hair?”
“Can I have a chair with wheel like that lady?”
Ah…the unfiltered curiosity of children. My twin brother and I were masters of asking deeply personal, highly inappropriate questions at the absolute worst times. Our poor mother was (and still is) my go-to person for pretty much everything. Like many parents, I am sure she sometimes dreaded fielding our loud and awkward inquiries in public places, but she always handled it with patience (and the occasional deep sigh).
Fast forward to our teenage years, my mother probably braced herself for awkward questions about puberty, sex or some horrifying combination of the two. But life threw a different kind of curveball: at age 11, I was diagnosed with acute myeloid leukemia (AML). Suddenly, my questions weren’t just embarrassing—they were existential.
“Why is this happening to me?”
“Am I going to die?”
While she did not always have a definitive answer, she answered truthfully and the best she could. And now, more than 20 years post-treatment, I still go to her first when I have a health question.
Which led to the semen sample incident.
One particularly awkward situation came about after my oncologist suggested a fertility test to check if my cancer treatment had affected my ability to have children. Simple enough, right? So, I went to a lab and inquired about giving a semen sample. What follows is the conversation I had on the phone with my mother while walking home (yes, on a busy public street).
Me: Hey, so I went to the lab today about that fertility test. The lady was very clear that I could not provide the sample there.
Mom: (sighs) Jamie, I really don’t need to hear this. (pause) Wait, so they don’t even give you a private room?
Me: Apparently not! Also, I have to abstain for a few days beforehand, and the sample has to be delivered within a specific time frame.
Mom: But you don’t have a car and you won’t make it on time by bus! Oh no. (pause) Can’t they just do it another way? Like, stick a big needle in there?
Me: I really hope not.
Mom: I really don’t need to hear about this… (pause) Anyway, have I told you about my mammograms?
Me: Yes. Repeatedly.
Fertility: The Question No One Wants to Ask
One of the hardest parts of surviving childhood cancer is dealing with the long-term effects—many of which don’t show up until years later. Fertility is a big one. It wasn’t on my 11-year-old mind, but fast forward a couple of decades, and suddenly, it’s a very real concern.
For some childhood cancer survivors, fertility can feel like an unanswered question lurking in the background. The only way to find out is through awkward, slightly mortifying medical tests. It’s not always an easy subject to talk about, but it’s important. Whether you’re considering having kids, exploring options like sperm or egg freezing, or just trying to understand how treatment may have affected you, asking the question is the first step. And if those conversations feel too awkward to have with a doctor, well—there’s always your mom.
Jamie is a childhood cancer survivor who takes pride in his role as Communications Assistant at POGO. His creativity and self-described “weirdness” is reflected in his writing and his presentations at POGO staff meetings. Reading and playing video games would be his well-developed hobbies if only his beloved cat, Lupin, would just give him some alone time.
Managing Your Fertility: Current Options, Practical Strategies
VIEW THE PRESENTATIONS
Presentation Description:
This session presented a brief overview of options for fertility preservation in female and male survivors of childhood cancer. Mostly, the session reviewed the options for survivors who are unable to conceive post treatment. The session discussed the options for building a family using third party reproduction. The practical and legal perspectives were discussed for surrogacy, donor eggs and donor sperm
Speakers:
Sara R. Cohen, LL.B.
Fellow of the American Academy of Assisted Reproductive Technology Attorneys
Adjunct Professor, Osgoode Hall Law School
Karen Glass, MD, FRCS(C), FACOG
Reproductive Endocrinologist, CReATe Fertility Centre
Director, Oncofertility Program
Assistant Professor, University of Toronto.
Workshop A - Female Fertility: Your Questions Answered
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Presentation Description:
Fertility concerns are not unique to cancer survivors, but survivors often have exceptional circumstances that can affect fertility options. This workshop will answer your burning questions about female fertility, including options and next steps if you’re thinking of starting a family.
Speaker:
Ellen Greenblatt, MD, FRCSC
Medical Director, Centre for Fertility and Reproductive Health
Mount Sinai Hospital, Toronto
Workshop B - Male Fertility: Your Questions Answered
VIEW THE PRESENTATION
Presentation Description:
Fertility concerns are not unique to cancer survivors, but survivors often have exceptional circumstances that can affect fertility options. This workshop will answer your burning questions about male fertility, including options and next steps if you’re thinking of starting a family.
Speaker:
Michael Neal, BSc. (Hons), MSc
Scientific Director
ONE Fertility, Burlington
