Assisted Reproductive Technology in Breast and Gynecologic Malignancies: Cancer Risk, Fertility Preservation, and Post-Treatment Reproductive Outcomes

Assisted reproductive technology (ART) is increasingly utilized worldwide, yet concerns remain regarding its potential association with breast and gynecological malignancies and the safety of fertility-preservation strategies in cancer survivors. Ovarian stimulation exposes women to supraphysiologic hormone levels, raising questions about cancer risk, particularly for hormone-sensitive tumors. Current evidence, however, is largely reassuring. Registry-based studies and meta-analyses demonstrate no consistent increase in breast or endometrial cancer following ART, although endometrial cancer risk remains inconclusive despite large new cohorts. Cervical cancer has not been linked to ART exposure. For ovarian cancer, risk appears primarily driven by underlying infertility, parity, and endometriosis rather than ART itself, and no excess risk is observed among BRCA mutation carriers. In parallel, fertility preservation (FP) has become an integral component of gynecologic oncology care for reproductive-aged women. Strategies including cryopreservation of oocytes, embryos, or ovarian tissue, as well as fertility-sparing surgery or hormonal therapy, can be safely pursued in carefully selected early-stage cancers. Pregnancy and livebirth rates vary by diagnosis: outcomes are favorable after breast and cervical cancers, more limited in endometrial cancer due to endometrial receptivity challenges, and possible but less predictable in ovarian cancer, where stage and histology guide feasibility. Available observational evidence does not suggest a clear increase in recurrence risk among carefully selected patients, although evidence remains limited and long-term follow-up is needed. Overall, current data suggest ART is safe when individualized to patient and tumor characteristics, highlighting the importance of proactive fertility counseling, modified stimulation protocols, and multidisciplinary care to optimize oncologic and reproductive outcomes.