Fertility Preservation in Hematologic Malignancies: A Disease-Specific Framework for Urgent and Ethical Care

Background Fertility preservation (FP) is a critical aspect of cancer care, yet patients with hematologic malignancies face distinct barriers compared to those with solid tumors. Objective To provide one of the first comprehensive, disease-specific clinical frameworks and evidence-based strategies for fertility preservation in patients with hematologic cancers, addressing unique implementation challenges. Methods We conducted a narrative review of peer-reviewed literature from PubMed and Embase databases (2010-2025) using search terms including “fertility preservation,” “hematologic malignancies,” “oncofertility,” and disease-specific terms. We included studies addressing counseling practices, preservation strategies, utilization patterns, reproductive outcomes, and ethical considerations in leukemia, lymphoma, and multiple myeloma patients. Priority was given to clinical studies, systematic reviews, and international guidelines with evidence quality assessment. Results Provider-reported counseling rates have improved from <50% to 75%–95% in specialized centers, yet only 44% of hematopoietic cell transplant specialists routinely refer patients for fertility consultation. Live birth rates with cryopreservation techniques range from 26% to 41%, despite low utilization of preserved material. Emergency protocols, such as random-start ovarian stimulation, enable FP completion within 10–14 days. Advanced molecular screening enhances safety for ovarian tissue cryopreservation in leukemia patients by addressing contamination risks. Conclusions Despite established guideline support, fertility preservation implementation varies widely across hematologic oncology practice. Priority interventions should focus on standardizing early counseling protocols, expanding access to time-sensitive preservation techniques including in vitro maturation, implementing disease-specific molecular screening for tissue safety, and addressing persistent sociodemographic disparities to ensure equitable reproductive autonomy for all patients facing blood cancer treatment.