ASCO Clinical Practice Guideline Update: Fertility Preservation in Patients With Cancer

As reported in the Journal of Clinical Oncology by Kutluk Oktay, MD, PhD, of Yale University School of Medicine, and colleagues, ASCO has issued a clinical practice guideline update on fertility preservation in adults and children with cancer. The update was informed by an update panel systematic review of the literature published between January 2013 and March 2017.  Review of 61 relevant publications prompted no significant changes to the prior 2013 ASCO recommendations. The update panel was co-chaired by Dr. Oktay and Alison W. Loren, MD, of Perelman School of Medicine, University of Pennsylvania.

Key recommendations are summarized or reproduced below.

Key Recommendations

  • Health-care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible.
  • Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists.
  • Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation.
  • The discussion of threats to fertility and fertility preservation options should be documented.
  • Sperm, oocyte, and embryo cryopreservation are considered standard practice and are widely available.
  • There is conflicting evidence to recommend gonadotropin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation.
  • The panel recognizes that when proven fertility preservation methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency.
  • GnRHa should not be used in place of proven fertility preservation methods.
  • The panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future.

Additional information is available at www.asco.org/survivorship-guidelines.

The corresponding author for the Journal of Clinical Oncology article is ASCO; email: guidelines@asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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