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As cancer survival rates improve in young men and women, fertility preservation becomes a topic that becomes relevant in malignant conditions. Additionally, several benign conditions may prompt women to consider their fertility preservation options, of which age-related fertility loss has gained popularity as more women choose to delay childbearing. Due to advances in assisted reproductive technologies, there are now a variety of methods to preserve fertility. This activity reviews the indications for fertility preservation in benign and malignant conditions and reviews fertility preservation techniques utilized by the interprofessional team. Objectives: Review the benign conditions in women that may lead to the need for fertility preservation, and describe age-related fertility loss in women. Identify the role of fertility preservation amongst transgender men and women. Summarize the approach to fertility preservation in a patient with a new diagnosis of cancer and how cancer treatments may lead to a loss of fertility. Describe fertility preservation techniques and indications. Access free multiple choice questions on this topic.

There are a variety of benign and malignant indications for women that may cause a patient to seek fertility preservation counseling. Several benign conditions that may lead to early infertility include endometriosis, ovarian torsion, benign ovarian cysts, and premature ovarian insufficiency, which may be a result of genetic conditions such as Turner syndrome, Fragile X premutation, or galactosemia. In addition, there are a variety of autoimmune medical conditions such as Lupus Nephritis and hematologic conditions such as sickle cell anemia and thalassemia that may require chemotherapy, radiotherapy, a combination of both chemotherapy and radiotherapy, and in some instances, even bone marrow transplantation.[1][2] These interventions for benign medical conditions may result in an early loss of fertility. Surgeries in the pelvis may also diminish a women's ovarian reserve and lead to issues with fertility.[3][4]

Interdisciplinary teamwork is important with fertility preservation. In cases where a patient is diagnosed with cancer, collaboration amongst the oncologist and reproductive specialists is key. The American Society of Clinical Oncology released an updated guideline in 2013 stating that oncologists should address the possibility of infertility with their patients before cancer therapy is initiated and should refer the patient to reproductive endocrinologists.[26] [Level 2] In cases of elective fertility preservation, the reproductive endocrinologist needs to collaborate with the primary care physician. It is also important for the financial department to determine the funding for the patient through insurance or organizations that donate to patients with a diagnosis of cancer.