Comment on: “Fertility Preservation in Patients With Medical Indications: A Committee Opinion”

Various medical conditions and treatments in young adults, adolescents, and children can impact future fertility, including increasing risk of premature gonadal failure. Preservation of fertility can decrease the overall risk of fertility in these patients, but its use remains low and is correlated with social determinants of health. This article is a summary of the components of comprehensive fertility preservation care as well as clinical recommendations for currently available methods of preservation. Components of comprehensive fertility care include timely initiation of counseling, rapid referrals, completion of treatment, post-treatment counseling, documentation, and assistance with financial navigation. Patient counseling should include all available options and all known and unknown risks to fertility associated with their medical condition(s) and treatment(s). Concrete documentation of consent, disposition of preserved tissue upon death, and storage arrangements should be kept by each party. Fertility preservation methods for female patients include mature oocyte cryopreservation and embryo cryopreservation, each with variations such as genetic testing, ovarian stimulation, or various starting protocols depending on the urgency of treatment. In addition, ovarian cryopreservation is now considered a safe and effective method, particularly for patients who cannot wait to begin treatment to undergo oocyte or embryo cryopreservation or ovarian stimulation. Safety considerations in female patients include medical complexity impacting the effectiveness and response to treatments, prevention of ovarian hyperstimulation syndrome (OHSS), consideration of ovarian suppression with GnRH analogs during chemotherapy treatment, and consideration of ovarian transposition in patients needing local pelvic radiation. In cases of gynecologic cancer, fertility-sparing surgical treatments should be considered. Emerging evidence has shown potential for the efficacy of newer treatments, including in vitro maturation, uterine fixation and transposition, and the application of existing strategies in adolescent patients and occasionally children. Methods of fertility preservation for male patients include ejaculated sperm cryopreservation, medically-assisted ejaculated semen collection, surgical sperm retrieval, and electroejaculation. Each method addresses specific fertility barriers, but all available options should be presented during patient counseling. Similar to female patients, clinics should have concrete policies and documentation surrounding the disposition of cryopreserved tissue after a patient’s death. All patients who are at risk of reproductive impairment from medical conditions or treatments should be made aware of all available options for fertility preservation and be provided with access to a multidisciplinary team to counsel with regarding preservation decisions. Each method of preservation has benefits and disadvantages, and each should be considered in the context of the situation of each individual patient. In minors, careful counseling should be undertaken with both the patients and their parents or guardians to achieve the best possible outcomes with informed consent from all involved. (Summarized from Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients with medical indications: a committee opinion. Fertil Steril . 2026;125:247–259. doi: 10.1016/j.fertnstert.2025.12.001)