ASCO has released an update to the guideline for fertility preservation in people with cancer. The update, recently published in the Journal of Clinical Oncology,1 provides recommendations regarding evaluation and counseling for fertility preservation; methods and timing of fertility preservation; and specific considerations for adults, adolescents, and children, so reproductive potential can be preserved whenever possible.
“Clinicians who care for young people with cancer know the importance of family-building for our survivors,” said the Guideline Co-Chairs Alison Loren, MD, MSCE, of the University of Pennsylvania, and H. Irene Su, MD, MSCE, of the University of California, San Diego, in an interview with ASCO Daily News. “This update informs them that there are an increasing number of medically effective interventions, which can be offered both before and after cancer treatment.”
The guideline notes that patients often do not receive adequate information or timely referrals to fertility specialists before starting cancer therapy, highlighting the need for clinical practice guidelines to aid clinicians in discussing with patients the potential effects of cancer treatment on fertility and options for preserving fertility.1 The evidence-based guideline was developed by a multidisciplinary Expert Panel and considered 166 studies published between January 2013 (the cutoff of the last literature search) and September 2024.
Importance of Fertility Discussions Throughout the Cancer Care Continuum
The guideline recommends that clinicians discuss the possibility of infertility with adult and pediatric patients as early as possible, before treatment starts, so the full range of options for fertility preservation is available. Fertility discussions should occur with all patients of reproductive potential, regardless of their planned treatment regimen, their demographic background, or their socioeconomic circumstances.
“Providing this information and supporting our patients can reduce distress and decision regret,” Dr. Loren and Dr. Su explained.
The co-chairs added that they “strongly emphasize the provision of reproductive health care throughout the cancer care continuum, especially after completion of therapy.” They noted that the reproductive health needs of young patients and families extend beyond diagnosis. Moreover, there can be a second window for fertility preservation after treatment of female patients.
Evolving Recommendations for Fertility Preservation
For male patients, fertility preservation focuses on sperm cryopreservation. The updated recommendations “provide expanded guidance around the impact of chemotherapy on the health and function of sperm and emphasize best practices to optimize the timing and quality of sperm cryopreservation,” the co-chairs explained. The update also now includes testicular sperm extraction as a standard-of-care option for men unable to produce a semen sample.
For women, the guideline addresses recent advances in fertility preservation, including ovarian tissue cryopreservation and transplantation as well as emerging technologies of in vitro maturation and uterine displacement.
Role of Oncology Clinicians in Maximizing Access to Reproductive Care
Dr. Loren and Dr. Su explained that the guideline also highlights the essential role of the oncology care team in overcoming barriers to fertility preservation through advocacy, awareness of bias, and ensuring access to financial and other resources.
Cost is a known barrier. The guideline adds recommendations on best practices for fertility preservation health insurance coverage. In addition, many states have passed insurance benefit mandates for fertility preservation, although the details regarding coverage vary by state. Clinicians should be aware of their state’s laws to understand what types of insurance cover fertility preservation and to support patient access.
Despite these barriers, the guideline co-chairs emphasize that infertility risk counseling and referral to fertility preservation care “should be universal for every young person with cancer, regardless of their sociodemographic circumstances, diagnosis, or urgency of cancer-directed treatment.”
Dr. Loren concluded that this guideline update “is much more expansive and inclusive than previous versions, and we hope [it] will spark lots of interest, discussion, and, of course, improved access to reproductive health care for all of our young patients.”
REFERENCE
1. Su HI, Lacchetti C, Letourneau J, et al: Fertility preservation in people with cancer: ASCO guideline update. J Clin Oncol. March 19, 2025 (early release online).
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, March 19. 2025. All rights reserved.
