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Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection

Murat Sonmezer, MD
Kutluk Oktay, MD, PhD, FACOG
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Treatment of malignancy, as well as some precancerous and benign conditions (table 1), may necessitate surgical resection of reproductive organs or administration of gonadotoxic chemotherapy or radiation therapy (table 2). This often leads to infertility, which is a major quality of life concern.

With appropriate pretreatment planning and intervention, biologic parenthood is possible for many men and women who will lose reproductive function because of surgery or gonadotoxic treatment. This topic will discuss several measures for preserving fertility in young women (table 3) and men receiving potentially gonadotoxic agents. The approach to fertility preservation in healthy women who wish to delay child-bearing is discussed separately. (See "Fertility preserving options for women of advancing age".)


Prior to initiating potentially gonadotoxic therapy, physicians should discuss the risk of treatment-induced infertility and possible interventions to preserve fertility [1]. Whenever possible, all patients with newly diagnosed cancer should meet with a reproductive endocrine and infertility specialist if fertility is a concern, preferably before treatment. In a retrospective review of 303 women aged 40 years and younger with breast cancer, only 80 women (26 percent) had a documented fertility discussion with their physician, but of these women nearly 90 percent pursued further consultation for fertility preservation [2]. This discussion should occur soon after diagnosis since some interventions to preserve fertility take time and could delay the start of treatment. Early referral to a reproductive endocrinologist can be useful. Advances in chemotherapy have led to development of less gonadotoxic treatment regimens for many cancers, such as Hodgkin lymphoma.

Fertility preservation requires individualization. The optimal approach depends upon the type of gonadotoxic treatment (radiation versus chemotherapy), time available, patient age, the specific disease, whether the patient has a partner, costs, and long-term issues (storage and use of frozen gametes or embryos). Our approach to decision-making in patients with cancer is shown in the figure (algorithm 1). The American Society of Clinical Oncology (ASCO) and the American Society of Reproductive Medicine (ASRM) have published similar recommendations [3-5].

In addition to the current topic, the following topics may be useful for patient counseling:

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Literature review current through: Nov 2017. | This topic last updated: Aug 30, 2017.
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