Preservation of fertility in adults and children diagnosed with cancer

#### Summary points In the United Kingdom each year 11 000 patients aged 15-40 years are diagnosed with cancer, and more than half of them will live for more than five years.1 2 Patients want quality of life, including the ability to have a family, and many request advice on fertility preservation. This review describes the fertility preservation techniques available and recent recommendations from the UK and the United States.3 4 5 #### Sources and selection criteria We searched Medline and the Cochrane library using the keywords “cancer and fertility”, “chemotherapy and fertility and radiotherapy and fertility”, “fertility preservation”, “ovarian transposition”, “oocyte freezing/cryopreservation”, “sperm freezing/cryopreservation”. We also used information from the National Institute for Health and Clinical Excellence; the Royal College of Physicians, Royal College of Radiologists, and Royal College of Obstetricians and Gynaecologists working party; and the American Society of Clinical Oncology. Chemotherapy and radiotherapy reduce the number of germ cells within the ovary and decrease testicular spermatogenesis; this reduction is related to the dose, agent used, and age at treatment. In addition, patients are at risk of permanent gonadal failure.3 4 The persistence of menstrual cycles after treatment does not preclude ovarian damage, and the preservation of testosterone production does not confirm the preservation of spermatogenesis. UK and American Society of Clinical Oncology (ASCO) guidelines recommend that the implications of oncological treatment for fertility are discussed with patients.3 5 The need to refer for fertility …