Approach For Fertility Preservation Research Articles

Fertility Preservation in Women with Turner Syndrome: A Comprehensive Review and Practical Guidelines

In this article we review the existing fertility preservation options for women diagnosed with Turner syndrome and provide practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in women, occurring in approximately 1 in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency and infertility. Although approximately 70%-80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder might possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood because the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, and cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remains investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 years of age and ovarian tissue cryopreservation in affected prepubertal children. However, current efficacy of these approaches is unknown in this cohort. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of the desire for parenting. For those with Turner syndrome-related cardiac contraindications to pregnancy, use of gestational surrogacy allows the possibility of biological parenting using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.

Testicular function and fertility preservation after treatment for haematological cancer.

Treatment for high-risk or relapsed haematological malignancy with haematopoietic stem cell transplantation is known to cause infertility. Today, there are no established options for fertility preservation in pre-pubertal boys. This review aims to describe how therapy for haematological malignancy in childhood affects male fertility, and to summarize recent developments for fertility preservation in these patients. Eventual recovery of spermatogenesis is probable after chemotherapy-based conditioning for haematopoietic stem cell transplantation. However, conditioning with total body irradiation is associated with a very high risk of permanent infertility. For high-risk patients, auto-transplantation of cryopreserved testicular tissue or cells might represent an approach for fertility preservation; however, contamination of testis tissue with malignant cells may prevent their subsequent reintroduction into patients. Recent progress using in-vitro differentiation of germ cells combined with assisted reproductive techniques may, in the future, represent a suitable alternative to retransplantation. Particular care must be taken when assessing infertility risk in patients with haematological malignancy as reclassification to high risk may significantly increase the likelihood of treatment-related gonadotoxicity. Importantly, development of fertility preservation strategies in such high-risk patients must also take into account specific risks for haematological cancers including cancer cell contamination.

Random-start IVF treatment: An emergent fertility preservation technique between cytotoxic treatment courses and stem-cell transplantation in acute myelocytic leukemia

Abstract Objective To report the ability to undergo two successive emergency IVF cycles between the cytotoxic treatments for a patient with AML waiting for stem-cell transplantation. Design Case report. Setting Fertility unit of a tertiary university medical center. Patient(s) A 28-year old woman diagnosed with AML and went through cytotoxic treatment. Intervention(s) Two emergency IVF cycles and OPU with embryo cryopreservation within 45 days between the cytotoxic treatment courses. Main outcome measure(s) Number of oocytes and/or embryos cryopreserved after two random start COSs. Result(s) 18 eggs were retrieved totally and a combined standard IVF/ICSI technique was used to fertilize them. 12 eggs fertilized and divided and all of them cryopreserved at day-2 stage. Conclusions Although it is still experimental, emergency IVF treatment considered as a novel approach for fertility preservation in cancer patients not only before the start of chemotherapy but even between the treatment courses if the patient’s physical and psychological conditions are stable and acceptable.

IVM oocyte cryopreservation after ex-vivo oocyte retrieval in gynecologic cancer patients undergoing radical surgery

In case of advanced gynecologic malignancy, radical surgery is necessary and reproductive organs such as uterus and ovaries could not be spared. Here we report novel approach for fertility preservation (FP) by means of ex-vivo retrieval of immature oocytes from macroscopically normal ovarian tissue harvested during radical surgery in endometrial or ovarian cancer patients with advanced stage.

First in vitro maturation (IVM) of oocytes retrieved from extracorporeal ovarian tissue aspiration leading to livebirth

We previously reported a novel fertility preservation approach consisting of IVM of oocytes retrieved from whole ovary surgical specimens. This intervention salvages immature oocytes with fertility potential that are otherwise wasted and offers a second tier intervention for patients already planning to undergo ovarian tissue freezing. The objective of this abstract is to report a livebirth after IVM of oocytes retrieved from extracorporeal ovarian tissue aspiration.

Laparoscopically-assisted, Hysteroscopic Removal of an Interstitial Pregnancy With a Fertility-Preserving Technique

Described is a novel surgical management of an unruptured interstitial pregnancy with preservation of the ipsilateral fallopian tube and uterine cornua. The patient was a 34-year-old woman, gravida 3, para 1, with an unruptured left interstitial pregnancy at 9 weeks' gestation, who desired preservation of fertility. The ectopic pregnancy was entirely removed via laparoscopically assisted hysteroscopy with a fertility-preserving surgical technique, with minimal blood loss, preservation of reproductive organs, restoration of anatomy, a patent ipsilateral fallopian tube, and expedient return to normal reproductive function. After the procedure, serial human chorionic gonadotropin levels were obtained until they were <5 mIU/mL. A hysterosalpingogram obtained 2 months after the procedure showed normal uterine and fallopian tube contour and bilateral tubal patency. We conclude that this laparoscopically assisted hysteroscopic technique is a safe and efficient fertility-preserving approach to management of an unruptured interstitial pregnancy.

Ongoing Pregnancy of Viable Gestational Age after In Vitro Maturation (IVM) of Oocytes Retrieved from Whole Ovary Tissue Aspiration

We previously reported a novel fertility preservation approach consisting of IVM of oocytes retrieved from whole ovary surgical specimens. This intervention salvages immature oocytes with fertility potential that are otherwise wasted and offers a second tier intervention for patients already planning to undergo ovarian tissue freezing.

Vitrification du tissu testiculaire : évolution ou révolution ?

Preservation of reproductive health is a major concern for patient long-term quality of life. While sperm freezing has proven to be effective to preserve fertility after puberty, cryopreservation of immature testicular tissue (ITT) is emerging as a promising approach for fertility preservation in young boys. Slow-freezing (SF) is the conventional method used to preserve ITT and has resulted in the birth of mice offspring. In humans, methods to preserve ITT are still at the research stage. Controlled SF using dimethyl sulfoxide showed preservation of proliferative spermatogonia after thawing in a xenotransplantation model used to evaluate the efficiency of freezing and thawing procedures. However, spermatogonial recovery was low and normal differentiation could not be achieved. Both freezing/thawing and the environment of the xenotransplantation model may be implicated. Indeed, with SF, ice crystal formation could damage tissue and cells. For this reason, vitrification, leading to solidification of a liquid without crystallization, may be a promising alternative. ITT vitrification has been investigated in different species and shown spermatogonial survival and differentiation to the round or elongated spermatids stage. Offspring were also recently obtained after vitrification and allotransplantation in avians, confirming the potential of vitrification for fertility preservation. In humans, vitrification appears to be as efficient as SF in terms of spermatogonial survival and initiation of differentiation after xenotransplantation. However, before validation of such fertility preservation methods, completion of normal spermatogenesis and the fertilization capacity of sperm retrieved from cryopreserved and transplanted tissue should be fully investigated.

Replacement of sodium with choline in slow-cooling media improves human ovarian tissue cryopreservation

Ovarian tissue cryopreservation is a promising technique for fertility preservation in young female cancer patients and efforts have been made to improve its effectiveness. During cooling and thawing, sodium ions significantly contribute to the ‘solute effect’ that plays a major role in disrupting cell membranes. Choline ions, which do not cross the cell membrane, should not contribute to the intracellular solute load. The present study assessed the effects of sodium substitution with choline in slow-cooling freezing media on human ovarian cortical strip cryopreservation. A total of 629 follicles (fresh control n=266; cryopreserved n=363), collected from ovarian biopsies of 11 women (22–40years) during laparoscopic surgery, were studied by light microscopy, immunohistochemistry and transmission electron microscopy to evaluate their morphology, apoptosis and ultrastructure. The results demonstrate that choline substitution leads to: (i) an improved preservation of oocytes and follicular cells; (ii) the recovery of a higher percentage of grade-1 follicles negative for p53, p21 and Apaf-1 apoptotic markers; (iii) a reduced mitochondrial damage as observed at an ultrastructural level; and (iv) a better preservation of ovarian tissue stroma. In conclusion, the use of choline-based media may represent a valuable tool to improve human ovarian tissue cryopreservation.Ovarian tissue cryopreservation is a promising fertility preservation approach for cancer patients before undergoing treatments that irreversibly reduce the ovarian reserve. Autotransplantation of ovarian cortical strips has resulted in viable offspring in animal models and human. Worldwide, 20 live births have been reported thus far following autotransplantation of frozen–thawed ovarian tissue. However, currently the success rate of this technology is far from being satisfactory. This could be due to inappropriate cryopreservation procedures that might impair the physiology of ovarian follicles. Sodium ions contained in freezing media significantly contribute to the ‘solute effect’ that plays a major role in disrupting cell membranes. Choline ions, which do not cross the cell membrane, would not be expected to contribute to the intracellular solute load. In the present study we assessed the effects of sodium substitution with choline in slow-cooling freezing media on human ovarian cortical strip cryopreservation. A total of 629 follicles, collected from ovarian biopsies of 11 women (aged 22–40years) during laparoscopic surgery, have been studied by light microscopy, immunohistochemistry and transmission electron microscopy to evaluate their morphology, apoptosis and ultrastructure. Results demonstrated that choline substitution allowed: (i) a better preservation of oocytes and follicular cells; (ii) the recovery of an higher percentage of healthy follicles negative for apoptotic markers; (iii) a lower mitochondria ultrastructural damage; and (iv) a better preservation of ovarian tissue stroma. In conclusion, the use of choline-based media could represent a valuable tool to cryopreserve human ovarian tissue for fertility preservation.

Large Conization and Laparoendoscopic Single-Port Pelvic Lymphadenectomy in Early-Stage Cervical Cancer for Fertility Preservation

Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT) is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS) is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.

Optimising vitrification of human oocytes using multiple cryoprotectants and morphological and functional assessment

Oocyte vitrification is a clinical practice that allows preservation of fertility potential in women. Vitrification involves quick cooling using high concentrations of cryoprotectants to minimise freezing injuries. However, high concentrations of cryoprotectants have detrimental effects on oocyte quality and eventually the offspring. In addition, current assessment of oocyte quality after vitrification is commonly based only on the morphological appearance of the oocyte, raising concerns regarding its efficiency. Using both morphological and functional assessments, the present study investigated whether combinations of cryoprotectants at lower individual concentrations result in better cryosurvival rates than single cryoprotectants at higher concentrations. Surplus oocytes from IVF patients were vitrified within 24h after retrieval using the Cryotop method with several cryoprotectants, either individually or in combination. The morphological and functional quality of the vitrified oocytes was investigated using light microscopy and computer-based quantification of mitochondrial integrity, respectively. Oocyte quality was significantly higher using a combination of cryoprotectants than vitrification with individual cryoprotectants. In addition, the quality of vitrified oocyte varied depending on the cryoprotectants and type of combination used. The results of the present study indicate that observations based purely on the morphological appearance of the oocyte to assess the cryosurvival rate are insufficient and sometimes misleading. The outcome will have a significant implication in the area of human oocyte cryopreservation as an important approach for fertility preservation.

Multiple approaches for individualized fertility protective therapy in cancer patients.

In the last decade, fertility preservation has risen as a major field of interest, creating new interactions between oncologists and gynecologists. Various options, such as cryopreservation of ovarian tissue, have been developed and are currently routinely proposed in many centers. However, many of the options remain experimental and should be offered to patients only after adequate counseling. This paper addresses the efficiency and the potential of the different fertility preservation approaches.

Discussing Fertility Preservation Options With Patients With Cancer

IN JUNE 2006, THE AMERICAN SOCIETY OF CLINICAL ONcology published a series of recommendations on fertility preservation for patients with cancer, concluding that “To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.” These guidelines reflect the greater attention that has been given in recent years to the fertility complications that can occur as a result of cancer treatment (eg, chemotherapies and radiation). Other professional and collaborative societies, including the Oncofertility Consortium, Fertile Hope, the American Academy of Pediatrics, and the American Society for Reproductive Medicine, also have developed best-practice guidelines and educational resources to provide patients and physicians with the most recent research on fertility preservation treatments. Investigators within the field of oncofertility have examined how patients with a cancer diagnosis learn about the potential of cancer-related infertility, including how such patients weigh fertility preservation options. In understanding this information exchange and medical decision, researchers and best-practice guidelines have looked to the patient-physician relationship, particularly those relationships between patients and oncologists, as the primary opportunity for patients to become aware of potential fertility complications related to cancer treatment. However, a distressing information gap has been identified in which oncologists often do not discuss the issue of possible infertility with patients prior to initiating potentially damaging cancer treatments. Research (including studies of men and women patients and of patients diagnosed when younger than 18 years) has consistently shown that patients diagnosed with cancer do not routinely discuss cancer-related infertility with their physicians. This information gap severely limits the ability of patients with cancer to take proactive steps to help safeguard their future fertility potential prior to fertility-compromising cancer treatments (TABLE). In light of these findings, researchers have begun to examine factors that may have prevented this exchange of information between patient and oncologist. Some research has suggested that oncologists may not be aware of bestpractice guidelines, including ASCO recommendations, and that their knowledge on the topic may not be up to date. The lack of interprofessional networks with reproductive endocrinologists and fertility preservation facilities may further hinder oncologists from raising the issue. Another inhibiting factor is the nature of the relationship between patient and oncologist. For example, Rieker et al have suggested that oncologists may be more likely to discuss sperm banking with patients with whom they share a perceived similar status (eg, highly educated patients). Physicians have reported that certain patient characteristics can influence the likelihood that they would discuss fertility preservation, including a patient’s prognosis, sex, parenting status, marital status, age/pubertal status, ability to pay for such treatments, and even whether a patient is homosexual or is infected with human immunodeficiency virus. The inability of cancer survivors to become parents is an increasing concern within the oncofertility community, and, as the above research suggests, some patient groups may have less access to fertility preservation options prior to cancer treatment. More research is needed to identify additional constituents who may be missing this information, and best-practice guidelines would benefit from highlighting potentially vulnerable groups and suggesting strategies to meet their unique fertility concerns. Research is needed to examine the conditions under which this sensitive issue is effectively discussed in the clinical setting. Among patients who do discuss potential infertility, many feel their concerns are not adequately addressed. The topic of fertility preservation may be understated when it is presented along with myriad other potential adverse effects. Additionally, more effective educational materials may be required to help facilitate these conversations. Researchers also should consider how other health care professionals can be integrated into these discussions, along with an understanding of what fertility concerns may remain fol-

Efficacy and safety of ovarian stimulation before chemotherapy in 205 cases

Ovarian stimulation and cryopreservation of fertilized oocytes before cancer therapy is the best established and efficient fertility preservation technique and should still be considered before chemotherapy. Within a short time frame of 2 weeks, between 8.6 (18-25 y) and 5.1 (36-40 y) fertilized oocytes can be cryopreserved.

Potential indications for ovarian autotransplantation based on the analysis of 5,571 autopsy findings of females under the age of 40 in Japan

Ovarian cryopreservation and autotransplantation could be of potential value for preservation of fertility in the patients with various malignancies. Ovarian tissue should be cryopreserved actively for fertility preservation, but stored tissue should be autotransplanted with much caution until reliable methods are established to detect minimal residual disease in grafts in precise and reproducible manners.

Mohs micrographic surgery for fertility preservation in a 46 XX true hermaphrodite

OBJECTIVE: To present a novel surgical approach for fertility preservation in a true hermaphrodite who is status-post a unilateral salpingo-oophorectomy for an ovotestis with a gonadoblastoma.DESIGN: Case report.MATERIALS AND METHODS: 20-year-old nulliparous African-American female who was found to have a left ovotestis with a gonadoblastoma and intratubular germ cell neoplasia on pathology after undergoing an exploratory laparotomy and left salpingo-oophorectomy prior to admission for a persistent 9 cm complex left adnexal mass. A CT scan of her abdomen and pelvis did not reveal any evidence of metastatic disease and ovarian tumor markers were negative. Of note, she has had clitoromegaly since she was an infant, and moderate facial acne that developed after puberty. Endocrine studies were significant for an elevated serum total testosterone (66ng/dL range: 2-45ng/dL) and normal free testosterone, 17-hydroxyprogesterone and DHEA-S levels. Peripheral blood karyotype was 46XX. She was referred to the Gynecology Service at the NIH to undergo additional testing to rule-out the presence of a contralateral ovotestis and gonadoblastoma in order to preserve her remaining ovary. Repeat endocrine studies now revealed a normal serum total testosterone level, and genetic testing for SRY was negative. A transvaginal ultrasound revealed a polycystic right ovary. Complete absence of an ovotestis with a gonadoblastoma is impossible to predict without a tissue diagnosis, a decision was made to perform Mohs micrographic surgery of the contralateral ovary in an attempt to preserve it.RESULTS: During the Mohs micrographic surgery, thin slices of ovarian tissue and a wedge resection were obtained from the hilum and sent for intra-operative frozen sections. Pathology revealed stromal cells with no evidence of testicular tissue or a gonadoblastoma, and no further dissections were performed.CONCLUSIONS: True hermaphroditism is characterized by the presence of both ovarian and testicular tissue. There may be an ovary on one side and a testis on the other, but more commonly one gonad is an ovotestis. Although the incidence of bilateral gonadoblastomas and gonadal neoplasia in 46 XX true hermaphrodites is rare, in the absence of a tissue diagnosis they cannot be ruled-out. Mohs micrographic surgery of the ovary represents a novel surgical approach to preserve fertility in these patients while making a tissue diagnosis. OBJECTIVE: To present a novel surgical approach for fertility preservation in a true hermaphrodite who is status-post a unilateral salpingo-oophorectomy for an ovotestis with a gonadoblastoma. DESIGN: Case report. MATERIALS AND METHODS: 20-year-old nulliparous African-American female who was found to have a left ovotestis with a gonadoblastoma and intratubular germ cell neoplasia on pathology after undergoing an exploratory laparotomy and left salpingo-oophorectomy prior to admission for a persistent 9 cm complex left adnexal mass. A CT scan of her abdomen and pelvis did not reveal any evidence of metastatic disease and ovarian tumor markers were negative. Of note, she has had clitoromegaly since she was an infant, and moderate facial acne that developed after puberty. Endocrine studies were significant for an elevated serum total testosterone (66ng/dL range: 2-45ng/dL) and normal free testosterone, 17-hydroxyprogesterone and DHEA-S levels. Peripheral blood karyotype was 46XX. She was referred to the Gynecology Service at the NIH to undergo additional testing to rule-out the presence of a contralateral ovotestis and gonadoblastoma in order to preserve her remaining ovary. Repeat endocrine studies now revealed a normal serum total testosterone level, and genetic testing for SRY was negative. A transvaginal ultrasound revealed a polycystic right ovary. Complete absence of an ovotestis with a gonadoblastoma is impossible to predict without a tissue diagnosis, a decision was made to perform Mohs micrographic surgery of the contralateral ovary in an attempt to preserve it. RESULTS: During the Mohs micrographic surgery, thin slices of ovarian tissue and a wedge resection were obtained from the hilum and sent for intra-operative frozen sections. Pathology revealed stromal cells with no evidence of testicular tissue or a gonadoblastoma, and no further dissections were performed. CONCLUSIONS: True hermaphroditism is characterized by the presence of both ovarian and testicular tissue. There may be an ovary on one side and a testis on the other, but more commonly one gonad is an ovotestis. Although the incidence of bilateral gonadoblastomas and gonadal neoplasia in 46 XX true hermaphrodites is rare, in the absence of a tissue diagnosis they cannot be ruled-out. Mohs micrographic surgery of the ovary represents a novel surgical approach to preserve fertility in these patients while making a tissue diagnosis.

Oocyte vitrification: A new approach for fertility preservation in cancer patients

20727 Background: Oocyte cryopreservation is a useful tool for fertility preservation in cancer patients at risk of losing the ovarian function due to the use of potentially sterilizing treatments. Results obtained with different cryopreservation protocols have been disappointing, particularly those obtained with slow cooling procedures. Vitrification has recently proven to be efficient enough to achieve its application in clinical practice. The aim of this study is to describe the results obtained with Cryotop method for oocyte vitrification in a population of oocytes recipients. Methods: Forty-seven donors and 57 oocyte recipients were included in this study. A total of 693 MII oocytes were collected after ovarian stimulation using long protocol down-regulation plus gonadotrophin administration. Vitrification was carried out by Cryotop method. Oocytes were donated to a proper recipient once the endometrial preparation was ready for the reception. Results: Of the 693 oocytes, 666 (96.1%) survived. A total of 487 (73.1%) were normally fertilized. The table shows clinical results. Conclusion: These results obtained in a population not affected by cancer show that oocyte cryo-banking, could be established realistically by applying the Cryotop vitrification method, offering excellent survival rates as well as a clinical outcome similar to the one obtained with fresh oocytes. Cancer patients could benefit from this approach for safeguarding their fertility, previous to the onset of the chemotherapy. Nº Embryo transfers 57 Embryos transferred (mean ± SD) 117 (1,99 ± 3,7) Pregnancy rate/transfer 36 (63.2) Implantation rate (Nºsacs/ Nº embryos transferred) 45 (38.5) Multiple pregnancy rate (twin) 11 (30.5) Miscarriage rate 6 (16.6) Biochemical pregnancy 5 (13.9) Ongoing pregnancy rate 25 (69.4) No significant financial relationships to disclose.

Ovarian cryopreservation with transposition of a contralateral ovary: a combined approach for fertility preservation in women receiving pelvic radiation

To describe a technique of fertility preservation by ovarian transposition combined with ovarian cryopreservation in the setting of oncologic pelvic radiation for a reproductive age woman. Case report. IVF center at a tertiary care hospital. Thirty-year-old nulligravid women who previously underwent lumbar spinal cord tumor debulking requested fertility preservation before pelvic radiation. Laparoscopic ovarian transposition with cryopreservation of the contralateral ovary. New technique in fertility preservation. Laparoscopic surgery was used to evaluate, select, and remove a single ovary that then underwent cryopreservation. Transposition of the remaining ovary was subsequently successfully performed, placing it of out of the pelvis. The combination of ovarian cryopreservation and ovarian transposition may maximize future fertility options for women facing pelvic irradiation. This combined approach should be included among the options offered to reproductive age women before pelvic radiation.

P-478: Fertility preservation in young women diagnosed with cervical carcinoma

Invasive cervical cancer affects about 10,370 women in the US and 500,000 worldwide per year. In the US about 16% of those are less than 39 years (1659 cases) The aim of this report is to describe an approach for fertility preservation in reproductive age women with cervical carcinoma.

American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients

To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.