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Fertility preservation

What's new

The American Society of Clinical Oncology (ASCO) has updated its guidelines on fertility preservation in patients with cancer. For male patients, sperm cryopreservation is recommended before cancer treatment, with testicular sperm extraction suggested if semen samples cannot be provided. For female patients, recommended methods include embryo, oocyte, and ovarian tissue cryopreservation, ovarian transposition, and conservative gynecologic surgery. In vitro maturation of oocytes may be offered as an emerging option. .

Background

Overview

Definition
Fertility preservation for patients with cancer is a therapeutic option designed to maximize the reproductive future of oncological patients, including oocyte/embryo cryopreservation for female patients and sperm cryopreservation for male patients.
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Pathophysiology
Fertility preservation for patients with cancer is for female and male cancer patients at risk for infertility due to anticancer treatment.
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Disease course
Fertility preservation techniques for females include embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (for pediatric and patients with hormone-dependent diseases), ovarian transposition (oophoropexy), fertoprotective adjuvant agents. Emerging techniques include activation of ovarian follicles, in vitro follicle culture, artificial ovaries, and specific target tissue drugs (nanoparticles, novel fertoprotective agents). Fertility preservation techniques for males include cryopreservation of spermatozoa and cryopreservation of SSC in prepubertal children.
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Prognosis and risk of recurrence
Fertility preservation for patients with cancer is not associated with increased mortality.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of fertility preservation are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2025), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2025,2023), the European Society of Human Reproduction and Embryology (ESHRE 2020), the European Society of Medical Oncology (ESMO 2020), and the ...
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Classification and risk stratification

Risk assessment: as per ASCO 2025 guidelines, offer an evaluation and counseling regarding the risk of reproductive function impairment and infertility in patients with cancer to ensure they are informed and supported in managing the potential reproductive impacts of their cancer treatment. Take into account the following in the assessment:
specific patient groups at high risk due to the gonadotoxic nature of therapies they receive or could receive in the future, and those on longer-term treatments delaying or precluding the ability to conceive
patients for whom the risk remains uncertain due to the unknown reproductive toxicity of many cancer-directed therapies
the effect of chronologic age for females due to increased infertility risk with concomitant aging.
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Diagnostic investigations

Ovarian reserve testing: as per ESHRE 2020 guidelines, obtain antral follicle count or anti-Müllerian hormone level measurement for predicting high and low responses to ovarian stimulation.
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Medical management

Setting of care
As per ESMO 2020 guidelines:
Refer all patients with a potential interest in fertility preservation to an appropriate fertility specialist/unit.
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Offer fertility preservation strategies preferably at the time of diagnosis before treatment initiation.
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More topics in this section

  • Fertility preservation in males (general principles)

  • Fertility preservation in females (oocyte/embryo cryopreservation)

  • Fertility preservation in females (ovarian tissue cryopreservation)

  • Fertility preservation in females (ovarian tissue retransplantation)

  • Fertility preservation in females (ovarian suppression)

  • Fertility preservation in females (aromatase inhibitors)

  • Fertility preservation in females (in vitro oocyte maturation)

  • Fertility preservation in females (ovarian transposition)

  • Fertility preservation in females (gonadal shielding)

  • Fertility preservation in females (uterine transposition)

  • Fertility preservation in males (sperm cryopreservation)

  • Fertility preservation in males (testicular tissue cryopreservation)

  • Fertility preservation in males (hormonal gonadoprotection)

  • Fertility preservation in males (gonadal shielding)

Specific circumstances

Pediatric patients, choice of procedure
As per ASCO 2025 guidelines:
Offer established methods of fertility preservation, such as semen or oocyte cryopreservation, in pediatric and adolescent patients who have initiated puberty, with patient assent and parent or guardian consent.
Consider offering ovarian or testicular cryopreservation in prepubertal patients, recognizing that testicular cryopreservation is currently investigational.
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  • Pediatric patients (counseling)

  • Pediatric patients (monitoring)

  • Patients with gynecologic malignancies

  • Patients with hereditary cancer syndromes

  • Patients with premature ovarian insufficiency

Patient education

General counseling: as per ASCO 2025 guidelines, discuss the possibility of infertility with adult and pediatric patients with cancer as early as possible before treatment to preserve the full range of options.
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Follow-up and surveillance

Pregnancy after cancer treatment: as per ESHRE 2020 guidelines, assess fitness for pregnancy, taking into account treatment late effects, the age of the patient, and the interval since treatment before the use of stored material.
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