Fertility Preservation and Oncofertility
Principles
Offer fertility preservation counseling before gonadotoxic therapy to all patients of reproductive age with cancer or other gonadotoxic exposure. Options depend on age, diagnosis, time to treatment, and partner status: embryo cryopreservation, oocyte cryopreservation, ovarian tissue cryopreservation (experimental/selected), and for males, sperm cryopreservation.
Risk stratification
Alkylating agents (cyclophosphamide) are high risk; radiation to pelvis is high risk. Age at treatment strongly predicts ovarian reserve after therapy. GnRH agonist cotreatment during chemotherapy may reduce ovarian failure risk in selected patients (e.g., breast cancer) but does not replace fertility preservation.
Traps
- Delaying cancer treatment for stimulation-coordination with oncology is essential; random-start protocols allow immediate stimulation.
- Assuming GnRH agonist is a substitute for oocyte/embryo cryopreservation.
- Forgetting sperm banking for male patients before therapy.
- Missing that pregnancy after cancer treatment is generally not contraindicated but should be timed with oncology.
Worked example
A 30-year-old with newly diagnosed breast cancer: refer urgently to reproductive endocrinology. Random-start stimulation and oocyte cryopreservation can proceed within ~2 weeks; GnRH agonist during chemotherapy may be added for ovarian protection.