CAR T-cell Therapy and Fertility | Considerations for Patients

New research presented at the 2025 ASH Annual Meeting shows the latest data on fertility counseling and preservation for people receiving CAR T-cell therapy. You will learn what certain centers currently do, where gaps exist, and why fertility conversations are becoming more important as CAR T-cell therapy is used earlier in care. 

Why fertility matters as CAR T-cell therapy expands

CAR T-cell therapy is a treatment that uses a person’s own immune cells. The cells are modified to better target cancer cells. It has shown strong results in certain blood cancers and is now being used earlier in treatment. Researchers are also studying it for some autoimmune conditions.

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As more young people receive CAR-T, long-term effects matter more. One concern is fertility, meaning the ability to have children in the future. Fertility may be affected not only by CAR-T itself, but also by earlier treatments and by lymphodepleting therapy, which prepares the body for CAR-T and often includes medicines known to harm egg and sperm production. 

How was fertility counseling handled before CAR-T? 

To better understand current practices, researchers from the European Society for Blood and Marrow Transplantation surveyed treatment centers across Europe. The survey asked how centers handle fertility counseling, fertility preservation options, and follow-up after CAR-T.

Out of 341 centers contacted, 63 centers responded. Most began CAR-T programs around 2019 and had treated a median of 56 patients each. Most patients treated had lymphoid blood cancers.

Most centers said they discuss fertility before CAR-T, but 17% reported they do not routinely talk with patients about fertility risks. This means some people may start treatment without knowing how it could affect future family planning. 

For patients, this highlights the importance of asking directly about fertility, especially if having children in the future is important to you.

Fertility preservation options are available

Most centers offered fertility preservation. About 78% provided options for women, and 79% for men. The most common reason for referral was a patient’s desire to have children, followed by younger age.

For men, sperm collection and freezing was the most common approach. For women, freezing eggs or ovarian tissue was the most frequently used option.

However, referrals did not always happen. The most common reasons for not referring patients were the urgency of treatment and having already received many prior treatments. This matters because delays in care are sometimes unavoidable, but early planning can make a difference. 

Pregnancies after CAR T-cell therapy are possible

Five centers reported seven pregnancies after CAR T-cell therapy. Four resulted in live births, including two in women who had frozen eggs before treatment. Two pregnancies were still ongoing at the time of the survey, and one miscarriage was reported.

While the numbers are small, this is important because it shows that pregnancy after CAR T-cell therapy can happen. 

Follow-up care after treatment was inconsistent

Hormone testing after CAR T-cell therapy varied widely between centers. Some commonly checked hormone levels, while others did not. Most centers did not recommend treatments aimed at resting ovarian function during therapy.

For patients, this means long-term follow-up plans may differ, and discussing hormone monitoring with your care team may be helpful.

What this study means for patients

This survey shows that fertility-related care around CAR T-cell therapy is inconsistent. As CAR-T moves earlier in treatment and reaches younger people, fertility counseling and preservation should become a routine part of care.

If you are considering CAR T-cell therapy, asking about fertility risks and preservation options before treatment can help you make informed decisions.

Read this abstract: Survey on fertility management and outcomes after cellular therapies, on behalf of the EBMT cellular therapy and immunobiology working party   

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