Fertility preservation (oncofertility, oocyte, embryo and ovarian tissue cryopreservation)

It is Tuesday morning, and your registrar hands you two referrals. The first is a 30-year-old nullipara with a new diagnosis of oestrogen-receptor-positive breast cancer; her oncologist wants chemotherapy started and the patient is asking what she can do about her fertility. The second is a 37-year-old solicitor, single, who wants to "freeze her eggs" before her fertility declines further. One patient has hours of oncological runway; the other has years of biological runway that she is already spending. Both deserve the same consultant skill: the first a rapid, multidisciplinary, structured preservation plan before the chemotherapy clock starts; the second an honest, age-stratified, evidence-based consultation that refuses to over-promise. This topic is that skill.^[1][3]

Overview and definition

Fertility preservation covers any intervention that protects or stores gametes, embryos or gonadal tissue before they are damaged — by cancer treatment, by surgery, by autoimmune therapy, or by age. The umbrella splits into medically indicated (oncofertility) and non-medical (elective, social) indications, and the established toolkit has five limbs.^[1][5]

• Oocyte cryopreservation — mature oocyte vitrification after stimulation. The established strategy for the post-pubertal female without a committed sperm source.^[3][6]
• Embryo cryopreservation — IVF/ICSI with partner or donor sperm and blastocyst vitrification. The longest track record and the highest live-birth yield per cycle.^[1][2]
• Ovarian tissue cryopreservation — laparoscopic cortical biopsy or oophorectomy with later reimplantation. The only established option for the prepubertal girl and for the patient with no time to stimulate.^[5][20]
• Ovarian suppression with a GnRH agonist — an adjunct that reduces chemotherapy-induced ovarian failure; ASCO is explicit that it is not a standalone fertility preservation method.^[2]
• Ovarian transposition (oophoropexy) — surgical relocation of the ovaries out of a pelvic radiation field.^[5][19]

^{[3] [18] [19] [1] [6]}

References20ShowHide

1. [1]Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines Ann Oncol, 2020.PMID 32976936
2. [2]Oktay K, Harvey BE, Partridge AH, et al. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update J Clin Oncol, 2018.PMID 29620997
3. [3]Cobo A, García-Velasco JA, Coello A, et al. Oocyte vitrification as an efficient option for elective fertility preservation Fertil Steril, 2016.PMID 26688429
4. [4]Cobo A, García-Velasco JA, Remohí J, et al. Oocyte vitrification for fertility preservation for both medical and nonmedical reasons Fertil Steril, 2021.PMID 33933172
5. [5]Sonmezer M, Sacinti KG, Oktay KH Female fertility preservation: 25 years of progress, expanding indications and future prospects Hum Reprod Update, 2026.PMID 41206517
6. [6]Practice Committee of the American Society for Reproductive Medicine Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion Fertil Steril, 2019.PMID 31843073
7. [7]Sönmezer M, Şükür YE, Saçıntı KG, et al. Safety of ovarian cryopreservation and transplantation in patients with acute leukemia: a case series Am J Obstet Gynecol, 2024.PMID 37666382
8. [8]Donnez J, Silber S, Andersen CY, et al. Children born after autotransplantation of cryopreserved ovarian tissue. a review of 13 live births Ann Med, 2011.PMID 21226660
9. [9]Shapira M, Dolmans MM, Silber S, et al. Evaluation of ovarian tissue transplantation: results from three clinical centers Fertil Steril, 2020.PMID 32605799
10. [10]Shapira M, Raanani H, Barshack I, et al. First delivery in a leukemia survivor after transplantation of cryopreserved ovarian tissue, evaluated for leukemia cells contamination Fertil Steril, 2018.PMID 29198847
11. [11]Moore HC, Unger JM, Phillips KA, et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy N Engl J Med, 2015.PMID 25738668
12. [12]Moore HCF, Unger JM, Phillips KA, et al. Final Analysis of the Prevention of Early Menopause Study (POEMS)/SWOG Intergroup S0230 J Natl Cancer Inst, 2019.PMID 30371800
13. [13]Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient-Level Data J Clin Oncol, 2018.PMID 29718793
14. [14]von Wolff M, Capp E, Jauckus J, et al. Timing of ovarian stimulation in patients prior to gonadotoxic therapy: an analysis of 684 stimulations Eur J Obstet Gynecol Reprod Biol, 2016.PMID 26927896
15. [15]Wald K, Cakmak H, Mok-Lin E, et al. Back-to-back random-start ovarian stimulation prior to chemotherapy to maximize oocyte yield J Assist Reprod Genet, 2019.PMID 31127475
16. [16]Kim J, Turan V, Oktay K Long-Term Safety of Letrozole and Gonadotropin Stimulation for Fertility Preservation in Women With Breast Cancer J Clin Endocrinol Metab, 2016.PMID 26751194
17. [17]Oktay K, Buyuk E, Libertella N, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation J Clin Oncol, 2005.PMID 15824416
18. [18]Li Z, Hou Y, Cheng Y, et al. Effect of grafting site on reproductive outcomes following cryopreserved ovarian tissue transplantation: a meta-analysis and systematic review Reprod Biol Endocrinol, 2025.PMID 41350899
19. [19]Habib N, Idoubba S, Futcher F, et al. Cervical Cancer Treatment and Fertility: What We Know and What We Do Cancers (Basel), 2025.PMID 41008899
20. [20]Cacciottola L, Donnez J, Dolmans MM Ovarian tissue and oocyte cryopreservation prior to iatrogenic premature ovarian insufficiency Best Pract Res Clin Obstet Gynaecol, 2022.PMID 34887172